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THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 


PRESENTED  BY 

PROF.  CHARLES  A.  KOFOID  AND 

MRS.  PRUDENCE  W.  KOFOID 


ULCERATION  OF  THE  OS  UTERI. 


AN  INQUIEY 


INTO  THE 


PATHOLOGICAL  IMPORTANCE 


ULCERATION  OF  THE  OS  UTERI. 


BEING 


THE  CROONIAN  LECTURES 


FOR  THE  YEAR  1854, 


BY 

CHARLES  WEST,  M.D., 

FELLOW   OF   THE    ROYAL   COLLEGE    OF   PHYSICIANS;    PHYSICIAN-ACCOUCHErR   TO 

ST.  BARTHOLOMEW'S    HOSPITAL;    PHYSICIAN    TO    THE   HOSPITAL 

FOR    SICK   children;    AUTHOR    OF    "LECTURES 

ON   THE   DISEASES   OF  INFANCY  AND 

CHILDHOOD,"   &C.   &C. 


PHILADELPHIA: 
BLAN  CHARD    AND    LEA 

1854. 


T.    K. 


PHILADELPHIA: 
AND    P.    G,    COLLINS,    PRINTER 


CONTENTS. 


LECTURE   I. 


Knowledge  of  diseases  of  women  imperfect,  and  its  progress  slow 
Employment  of  speculum,  and  disputes  as  to  its  value 
Peculiarities  of  uterus  in  health  and  disease 
Ulcerations  of  os  uteri  described;  their  alleged  Importance 
Doubts  suggested;  and  plan  of  inquiry  proposed 
I.  Evidence  of  physiology    .         .         . 
II.  Evidence  of  morbid  anatomy    .         .      •  . 


PAGB 

11 
21 

22 
26 
29 
31 
32 


LECTURE   II. 

Inquiry  continued.     III.  Results  of  ulceration  of  procident  uterus  41 

ly.  Results  of  clinical  observation ,        .  45 

Influence  of  ulceration  on  fecundity 49 

Comparison  of  symptoms  in  absence  of,  or  in  connection 

with  ulceration 51 

Conclusions  from  inquiry 60l 


LECTURE    III. 

Inquiry  into  causes  of  uterine  ailments 
Constitutional  causes  frequent  and  various   . 
Local  causes ;  sequelae  of  abortion  and  labor 
Other  causes  productive  of  hypertrophy 


6a 

64- 
68 
10 


M354G59 


Vlll 


CONTENTS. 


Results  of  inflammation  of  uterus;    and  their  independence  of 

ulceration 

Importance  of  affections  of  uterine  cavity  underrated — ^those  of 

cervix  over-estimated 

Symptoms  of  ulceration,  and  of  ailments  akin  to  it 
Local  treatment  of  ulceration      .... 
Objections  to  indiscriminate  local  treatment 
Conclusion 


71 

75 

78 
81 

85 

88 


AN    INQUIKY 


INTO   THE 


PATHOLOGICAL    IMPORTANCE 


OP 


ULCERATION   OF  THE   OS  UTERI 


LECTURE   I. 

Introduction — Imperfection  of  our  knowledge  concerning  the  Diseases  of  "Women; 
reasons  for  it.  State  of  opinion  at  time  of  first  employment  of  speculum ;  facts 
which  use  of  that  instrument  brought  to  light ;  different  estimates  of  its  value. 

Important  principles  involved  in  the  disputes  on  this  subject — Proposed  inquiry  into 
them  in  these  Lectures. 

Preliminary  remarks  on  some  peculiarities  of  the  uterus  in  health  and  in  disease — 
Supposed  cause  of  most  uterine  ailments — Alleged  importance  of  ulceration  of 
the  OS  uteri — Description  of  those  ulcerations — How  they  are  supposed  to  react 
on  the  uterus ;  suggestions  for  their  cure. 

Doubt  as  to  correctness  of  these  opinions — Plan  of  proposed  inquiry  into  them — 
I.  Conclusions  from  anatomy  and  physiology  unfavourable  to  them.  II.  Results 
of  examinations  after  death  hitherto  unsatisfactory,  and  why — Observations  of 
lecturer;  inferences  from  them  opposed  to  idea  of  great  importance  of  ulceration 
of  OS  uteri. 

Mr.  President — 

Sir  :  I  enter  on  the  honourable  task  which  you  have  assigned 
to  me,  with  much  apprehension  and  misgiving.  It  is  not  merely 
that  I  appear  in  the  teacher's  garb  before  those  from  whom  I  have 
learned  much,  and  might  still  be  well  content  to  learn  all  my  life 
long — nor  that  I  address  an  audience  whose  criticism  I  dread  and 
whose  unfavourable  censure  I  would  deprecate — which  fills  me  with 
anxiety ;  but  it  is,  that  I  am  here  to-day  in  some  sort  as  the  repre- 
sentative of  those  who  follow  a  department  of  medical  practice 
which,  till  but  recently,  this  College  scarcely  countenanced — to 
whom  it  has  but  lately  extended  honourable  distinctions — on  whom 
2 


18  IMPERFECTION   OF   KNOWLEDGE 

it  has  now  for  the  first  time  imposed  a  still  more  honourable  duty. 
While  I  rejoice,  Sir,  in  the  full  recognition  by  this  College,  of  the 
fact  that  all  departments  of  our  profession,  by  which  suffering  can 
be  assuaged,  disease  arrested,  or  life  prolonged,  are  alike  honour- 
able— that  none  are  alien  from  the  paths  of  scientific  inquiry,  nor 
unfriendly  to  that  culture  of  the  mind  which  confers  distinction 
more  precious  far  than  any  worldly  honours — I  dread  lest  anything 
that  comes  from  me  should  seem  unworthy  of  this  body,  undeserving 
of  that  liberality  of  sentiment  and  enlargement  of  view  to  which 
I  owe  it  that  I  have  now  the  opportunity  of  addressing  you. 

Never,  Sir,  have  I  wished  so  much  as  I  do  now  for  that  insight 
into  Nature's  ways,  which  might  enable  me-  to  justify  your  appoint- 
ment of  me  as  Croonian  Lecturer  for  this  year,  by  bringing  before 
this  assembly  some  new  truth,  or  by  throwing  fresh  light  on  some 
great  principle  but  dimly  seen,  or  partially  understood  before ;  or 
at  least  for  those  rare  gifts  of  speech  which  can  impart  interest  and 
freshness  even  to  subjects  trite  and  commonplace.  But,  while  to 
such  endowments  I  have  no  pretensions,  my  need  of  your  indulgence 
is  all  the  greater,  since  I  have  had  most  to  do  with  small  complaints 
and  e very-day  diseases ;  and  if  from  them  I  select  a  subject  for 
these  Lectures,  though  obscure,  it  still  must  seem  familiar,  and, 
with  all  the  disadvantages  of  novelty,  yet  have  none  of  its  charms. 

Frequent  as  is  the  occurrence,  it  must  nevertheless  be  confessed 
that  the  Diseases  of  Women  are  those  concerning  which  our  know- 
ledge is  most  defective.  And  yet  there  seems,  at  first  sight,  to  be 
but  little  reason  for  these  deficiencies ;  so  little,  indeed,  that  their 
existence  has  been  made  a  constant  ground  of  reproach  against 
those  who,  having  to  do  with  ailments  so  simple  as  they  are  assumed 
to  be,  yet  have  left  so  much  concerning  them  uncertain  or  unex- 
plored. I  believe,  however,  that  many  of  the  doubts  and  uncertain- 
ties which  beset  these  subjects  depend  on  the  difiiculties  in  the  way 
of  arriving  at  truth  concerning  them,  far  more  than  on  any  want 
either  of  diligence  or  of  honest  purpose,  on  the  part  of  those  whose 
special  duty  it  was  to  engage  in  their  investigation. 

If,  now,  for  a  few  minutes  I  occupy  your  time  in  the  endeavour 
to  point  out  whence  those  difficulties  have  arisen  which  did,  and  do 
still,  retard  the  advancement  of  knowledge  concerning  uterine  dis- 
ease, you  must  bear  with  me,  since  my  object  is  not  only  to  account 
for  the  apparent  omissions  of  obstetric  practitioners  in  general,  but 
also,  by  showing  the  uncertainty  of  much  that  we  seem  to  know, 


CONCERNINa  DISEASES   OF  WOMEN.  19 

to  excuse  myself  for  the  choice  which  I  have  made  of  a  subject  for 
these  Lectures. 

In  wonder,  says  the  ancient  writer,  all  philosophy  begins,  in 
wonder  it  ends ;  but  wide,  indeed,  is  the  distance  which  separates 
the  marvelling  of  the  ignorant  from  the  admiration  of  the  learned. 
Processes  such  as  those  by  which  the  perpetuation  of  the  species  is 
accomplished,  could  not  but  excite  in  every  stage,  the  wonder  of  all 
people,  in  all  times.  The  principle  of  life,  symbolized  under  various 
forms,  was  in  the  earliest  ages  the  object  of  reverence,  or  of  actual 
worship,  while  the  happy  issue  of  the  mysterious  process  of  parturi- 
tion was  sought  to  be  secured  by  rites  and  ceremonies,  and  charms, 
propitiating  the  various  deities  who  superintended  it.  If  these 
failed  of  their  looked-for  result,  or  if  some  untoward  event  hap- 
pened, passing  the  skill  of  the  attendant  women,  the  aid  of  the 
surgeon  was  sent  for,  though  only  to  perform  some  barbarous 
operation.  In  the  diseases  of  their  own  sex,  it  was  natural  that 
women  should  be  first  consulted ;  and  the  instances  were  compara- 
tively few  in  which  application  was  made  for  the  assistance  of  any 
physician :  hence  it  resulted,  from  sheer  w^ant  of  opportunity,  that 
the  anatomical  and  physiological  discoveries  which  were  made, 
though  slowly  and  imperfectly,  remained  long  unapplied ;  that  for 
ages,  all  knowledge  of  the  pathology  of  the  female  sex  continued 
fragmentary,  and  all  treatment  of  their  diseases  empirical. 

Nor  was  this  state  of  things  as  much  amended  as  might  have 
been  expected  by  the  general  advancement  of  knowledge  in  compa- 
ratively modern  times.  Anatomists  devoted  themselves  to  the  task 
of  exploring  the  mysteries  of  generation,  but  passed  by  without 
inquiry  the  scarcely  less  mysterious  process  of  parturition,  and  the 
changes  which  succeed  to  it ;  while,  by  their  unquestioning  adop- 
tion of  many  errors  which  time  had  rendered  venerable,  they  lent  to 
them  a  fresh  sanction,  and  gave  them,  as  it  were,  the  stamp  of 
truth.  In  subjects  thought  to  be  beneath  the  dignity  of  science, 
advances  must  needs  be  slow ;  and  the  whole  history  of  the  obstet- 
ric art  is  a  most  appropriate  commentary  on  this  fact.  By  slow 
degrees,  indeed,  and  by  steps  which  we  cannot  now  stop  to  trace, 
improvement  came,  though  amended  practice  in  this,  as  in  so  many 
other  instances,  preceded  correct  theory ;  and  even  now  we  not 
infrequently  do  what  experience  has  taught  us  to  be  right,  although 
we  are  unable  to  assign  a  thoroughly  satisfactory  reason  for  our 
proceeding. 


\ 


20        IMPERFECT   KNOWLEDGE   OF  DISEASES   OF   WOMEN. 

But  if  our  knowledge  be  still  incomplete  concerning  a  process  like 
that  of  parturition,  which  is  transf^cted  in  a  few  hours,  and  is  con- 
stantly offering  itself  to  our  observation,  there  is  little  cause  for 
surprise  that  it  should  be  still  more  imperfect  with  reference  to  the 
physiology  and  pathology  of  the  generative  system  in  the  unimpreg- 
nated  state.  So  recently,  indeed,  as  thirty  years  ago,  neither  was 
the  structure  nor  were  the  functions  of  the  sexual  organs  at  all  cor- 
rectly understood.  The  uterus,  it  is  true,  was  known  to  be  muscu- 
lar ;  but  neither  the  process  by  which  its  muscularity  becomes  so 
marked  during  pregnancy,  while  it  ceases  to  be  clearly  apparent 
soon  after  delivery,  nor  the  intimate  nature  of  its  structure  in  the 
virgin  state,  had  been  the  subject  of  inquiry.  The  interior  of  its 
neck  was  seen  to  be  invested  by  a  membrane  arranged  in  folds, 
between  which  minute  glands  or  follicles  were  present  in  great 
abundance ;  but  the  existence  of  a  distinct  lining  membrane  in  its 
cavity  was  rather  inferred  from  the  results  of  observation  in  some 
forms  of  disease,  than  demonstrated  by  anatomical  investigation  in 
a  state  of  health.  Though  the  structure  of  the  ovaries  was  in  the 
-  main  understood,  yet  the  ovarian  ovule  had  not  been  discovered, 
■  and  the  function  of  the  ovaries  was  supposed  to  be  called  into  exer- 
cise only  during  the  stimulus  of  sexual  congress.  Hence  it  resulted 
that  the  import  of  menstruation  continued  to  be  a  riddle  unread ; 
all  that  was  certainly  known  about  it  being  that  it  was  a  function 
which  bore  an  important,  though  undefined  relation,  to  the  genera- 
tive process. 

To  have  written,  under  such  disadvantages,  a  work  on  the  Dis- 
eases of  Women — so  full  of  sound  observation — so  abounding  in 
practical  instruction  of  the  highest  kind — that,  like  Pemberton's 
Treatise  on  the  Abdominal  Viscera,  it  has  not  only  not  been  ren- 
dered obsolete  by  the  lapse  of  time,  but  that  it  still  remains,  after 
forty  years,  our  safest  guide  in  the  management  of  these  diseases, 
is  certainly  not  the  least  among  the  many  honours  which  its  author 
has  won,  and  wears  so  well.  But,  in  trying  to  judge  fairly  of  the 
labours  of  our  more  immediate  predecessors,  or  to  estimate  what 
remains  for  us  to  do,  we  must  not  forget  that  where  the  knowledge 
of  healthy  structure  and  of  natural  function  is  defective,  the  know- 
ledge of  diseased  structure  and  of  perverted  function  must  be  imper- 
fect too. 

Very  few  facts  will  suffice  to  illustrate  the  defective  pathology 
of  but  a  few  years  ago.     It  was  assumed  that  an  organ  of  such 


EMPLOYMENT  OF   SPECULUM.  21 

dense  structure  as  the  unimpregnated  uterus  must  be  little  liable 
to  inflammation,  and  its  kindred  processes ;  though  in  some  rare 
cases  the  neck  of  the  womb  was  allowed  to  be  their  seat.  Its  lining 
membrane,  supposed  to  be  so  rudimentary  in  the  unimpregnated 
state,  was  not  thought  worth  consideration  among  the  possible  seats 
of  disease ;  and  leucorrhoeal  discharges,  supposed  to  be  always 
furnished  by  the  vagina,  were  usually  regarded  as  the  consequence 
and  the  index  of  constitutional  debility.  The  different  morbid 
growths  were  not  properly  discriminated;  scirrhus,  a  disease  of 
extreme  rarity,  was  assumed  to  be  of  very  frequent  occurrence ; 
and  to  it  were  attributed  almost  all  chronic  affections  of  the  neck  of 
the  womb,  attended  with  induration  of  its  substance  and  increase  of 
its  size. 

In  this  state  of  knowledge,  when  observation  must  have  been 
perpetually  clashing  with  preconceived  opinions,  M.  Recamier  first 
thought  of  employing  an  instrument — the  Speculum — for  the  more 
convenient  application  of  local  remedies  to  cancerous  ulcerations  of 
the  womb.  Its  use,  however,  was  not  long  confined  to  this  object ; 
for  practitioners  found  that  by  means  of  it  they  were  enabled  to 
discover  yarious  morbid  conditions  of  the  uterus,  with  which  they 
were  hitherto  unacquainted,  and  to  which  it  w^as  but  natural  to 
attach  importance,  as  the  probable  cause  of  many  previously  inex- 
plicable symptoms.  In  fact,  by  its  means  one  important  question 
was  speedily  and  decisively  set  at  rest — for  leucorrhoeal  discharges 
were  ascertained  to  be  derived  in  great  measure,  not  from  the 
vagina,  but  from  the  uterus ;  to  be  associated  with  various  diseased 
appearances  of  its  orifice,  and  to  be,  sometimes  at  least,  removed  by 
different  remedies  directed  to  that  part  and  to  the  neck  of  the 
womb.  So  long  as  the  lining  membrane  of  the  uterine  cavity  was 
supposed  to  exist  in  the  unimpregnated  state  merely  in  a  rudiment- 
ary condition,  it  was  most  natural  that  an  exaggerated  importance 
should  be  attached  to  the  various  morbid  appearances  of  the  os 
and  cervix  uteri ;  and  so  long  as  the  ovaries  were  believed  to  be 
called  into  activity  only  at  the  time  of  sexual  congress,  it  was  to  be 
expected  that  their  share  in  the  production  of  diseased  phenomena 
should  be  rated  very  low.  Ignorance,  with  reference  to  these  two 
points,  was  shared  alike  by  the  advocates  of  the  employment  of  the 
speculum,  and  by  the  opponents  of  its  use  ;  and  under  these  circum- 
stances their  controversies  were  not  likely  to  lead  to  any  satisfac- 
tory result. 


2Sf  PECULIARITIES   OF  THE   UTERUS 

We  need  not,  indeed,  wonder  that  the  disputants  on  both  sides, 
thus  imperfectly  furnished  for  the  debate,  should  have  narrowed 
the  question  to  one  of  details  touching  the  expediency  of  employing 
an  instrument  which  some  pronounced  to  be  all  important,  while 
others  decried  it  as  useless,  mischievous,  and  even  immoral.  It 
must  be  obvious,  however,  to  us  who  enjoy  the  advantage  of  the 
additions  to  physiological  knowledge  which  the  past  quarter  of  a 
century  has  brought  with  it,  that  our  decision  on  this  subject  in- 
volves much  more  than  the  mere  acceptance  or  rejection  of  a  certain 
therapeutical  proceeding,  but  that  it  really  concerns  the  opinions 
which  we  entertain  with  reference  to  the  main  principles  of  uterine 
pathology.  Regarded  in  this  light,  what  might  at  first  have  seemed 
a  trivial  inquiry,  at  once  assumes  a  greater  importance,  and  be- 
comes, I  think,  not  unworthy  the  attention  even  of  such  an  audience 
as  the  present. 

It  is  not  without  reluctance  that  once  again  I  venture  to  delay 
you  with  some  further  preliminary  considerations  touching  the 
structure  and  the  functions  of  the  womb ;  though  my  doing  so 
might  perhaps  be  justified  on  the  plea  of  the  desirableness  that  we 
should,  before  entering  on  an  examination  of  conflicting  opinions, 
ascertain  what  facts  are  accepted  as  true  on  either  side.  But  there 
is  another  reason  for  this  course,  in  the  circumstance  that  the  womb 
presents  peculiarities  of  situation,  structure,  and  function,  such  as 
render  it  probable  that  the  diseases  of  the  organ  may  likewise  ex- 
hibit distinctive  features,  and  possible  that  their  cure  may  call  for 
modes  of  treatment  which  otherwise  would  not  be  expedient,  nor  even 
justifiable. 

Now,  it  would  not  be  easy  to  imagine  a  state  of  things  more 
favourable  to  the  occurrence  of  ailments  dependent  on  venous  con- 
gestion, or  in  which  those  ailments  would  be  more  difficult  to  remove, 
or  more  apt  to  return,  than  is  observed  in  the  case  of  the  uterus 
during  the  whole  period  of  activity  of  the  generative  powers.  The 
return  of  blood  from  the  organ,  which  is  rendered  difficult  by  its 
situation  at  the  lowest  part  of  the  trunk,  is  still  further  impeded  by 
the  absence  of  valves  from  its  veins  ;  while  every  month,  for  several 
days  together,  this  organ  and  its  appendages  are  the  parts  towards 
which  blood  flows  in  superabundant  streams.  During  this  period, 
the  natural  secretion  from  the  uterus  and  Fallopian  tubes  is  much 
increased;  the  epithelium  covering  their  surface  is  detached,  and 
reproduced  again  and  again;  hemorrhage  breaks  forth  along  the 


IN   HEALTH   AND   IN   DISEASE.  28 

■whole  tract — and  it  is  not  until  this  has  continued  for  some  days, 
that  the  congestion  ceases  and  the  parts  subside  once  more  into 
their  former  state  of  quiescence — the  uterus  remaining,  however, 
for  a  short  time  heavier,  and  its  tissue  looser,  and  more  abundantly 
supplied  with  blood,  than  it  was  before.  I  need  not  stop  to  tell 
how  a  slight  cause  may  protract  this  hemorrhage,  or  how  some 
accident  may  check  it ;  nor  need  I  labour  hard  to  prove  that  in 
either  case  there  must  be  a  general  disturbance  of  the  function  of 
the  organ — a  general  impairment  of  the  health  of  the  individual : 
exhausted  in  the  one  instance  by  loss  of  blood,  broken  down  in  the 
other  by  the  suffering,  both  general  and  local,  which  the  return  of 
the  periodical  excitement  of  the  generative  organs,  unrelieved  by 
their  customary  depletion,  cannot  fail  to  bring  with  it.  In  what 
organ  of  the  body  does  one  find  a  parallel  to  this  series  of  occur- 
rences ? 

Again ;  the  uterus  is  held  in  its  position  by  supports  which  allow 
to  it  a  large  measure  of  mobility,  and  whose  power  is  generally 
diminished  by  the  very  causes  that  increase  the  weight  of  the  body 
they  have  to  bear.  Hence,  it  is  very  apt  to  become  displaced,  and 
to  be  displaced  in  a  downward  direction,  or  prolapsed.  And  such 
prolapsus  not  only  brings  with  it  a  variety  of  painful  sensations, 
due  to  the  womb  dragging  upon  its  ligaments,  but  the  moment  the 
organ  ceases  to  be  suspended  in  the  pelvic  cavity,  it  becomes  ex- 
posed to  shocks  of  various  kinds,  to  irritation  from  sources  from 
which  it  was  previously  safe.  The  neck  of  the  womb,  even  when 
that  descent  is  not  very  considerable,  becomes  a  sort  of  stem  on 
which  the  organ  rests  upon  the  floor  of  the  vagina.  In  this  position 
it  is  liable  to  disturbing  causes  almost  numberless — sitting,  riding, 
exertion  of  any  kind,  the  very  passage  of  the  feces  along  the 
rectum,  produce  pain,  keep  up  congestion,  and  favour  that  slow 
increase  of  size  which  seldom  fails  to  occur  in  parts  the  seat  of  long- 
continued  irritation,  and  which  offers  one  great  impediment  to  the 
cure  of  many  affections  of  the  womb. 

Another  peculiar  and  fertile  source  of  disorders  of  the  womb  is 
furnished  by  the  changes  that  attend  upon  conception  and  parturi- 
tion, and  their  frequent  interruption.  With  these  changes,  even  in 
the  healthy  state,  our  acquaintance  is  at  present  too  imperfect  for 
us  to  appreciate  with  accuracy  the  nature  of  the  mischief  which 
may  result  from  their  disturbance.  We  know,  indeed,  many  things 
concerning  these  processes  of  which  our  predecessors  were  ignorant ; 


24  PECULIARITIES   OP  THE   UTERUS 

but  our  increased  knowledge  is  as  yet  sufficient  to  show  us  the  dif- 
ficulties of  the  problem,  not  sufficient  to  furnish  its  solution.  The 
growth  of  the  pregnant  womb  is  not,  as  it  was  once  supposed  to  be, 
a  mere  increase  in  size  and  unfolding  of  texture  of  the  muscular 
fibres  already  present  there,  but  is  as  much  the  result  of  a  new 
formation  as  is  that  of  the  foetus  contained  within  it ;  its  tissues 
going  through  the  same  development  from  a  rudimentary  condition 
to  a  high  organization.  Cells  elongate  into  caudate  bodies ;  these 
unite  into  fibrillae,  while  the  mucous  membrane  increases  in  vascu- 
larity, grows  in  thickness,  and  becomes  developed  into  decidua. 
The  small,  dense,  lowly  organized  uterus  becomes  the  large,  vascu- 
lar, powerful  muscle  which  we  see  it  to  be  at  the  end  of  pregnancy ; 
when  having  served  as  the  residence  of  the  foetus,  and  as  the 
medium  through  which  it  derived  its  support,  the  organ  accom- 
plishes in  the  act  of  parturition  the  last  of  that  wonderful  series  of 
processes  to  which  it  owed  in  old  time  its  appellation  Miraculum 
Naturae.  But  even  before  this  period  has  arrived,  indications  of 
decay  have  manifested  themselves  in  the  changes  that  have  taken 
place  in  the  decidua  ;  while  no  sooner  is  the  child  born,  than  all  the 
tissues  of  the  womb  evince  the  commencement  of  similar  alterations, 
which  go  on  with  a  rapidity  such  as  is  observed  in  no  other  body 
and  under  no  other  circumstances.  The  muscular  fibres  undergo 
fatty  degeneration,  and  to  a  great  extent  disappear ;  nerve-matter 
ceases  to  be  apparent  within  the  sheaths  which  had  contained  it, 
while  even  the  fibres  of  elastic  tissue  interwoven  with  the  muscular 
substance  of  the  womb,  lose  their  distinctness  or  become  entirely 
absorbed.  The  old  uterus  has  done  its  work  and  is  removed ;  but 
in  the  midst  of  its  decaying  fibres  the  elements  of  a  new  organ  are 
developed,  and  the  microscopist  tells  us  of  a  new  generation  of 
spindle-shaped  cells,  which  he  can  discover  in  its  tissue,  just  like 
those  which  existed  in  the  organ  before  pregnancy  began,  and 
which  remain  stationary  at  the  same  low  stage  of  formation,  till  in 
their  turn  excited  by  impregnation  to  go  through  higher  phases  of 
development. 

In  these  changes,  the  body  of  the  uterus,  and  the  lining  of  its 
cavity,  bear  a  far  greater  part  than  either  the  substance  of  its 
cervix  or  the  mucous  membrane  which  lines  that  canal.  The 
mucous  membrane  of  the  body  only  is  developed  to  the  decidua, 
and  it  alone  is  thrown  ofi"  after  delivery ;  the  lining  membrane  of 
the  neck  undergoes  much  slighter  alterations,  and  is  not  deciduous. 


IN  HEALTH   AND   IN  DISEASE.  25 

It  is  in  the  body  of  the  uterus  that  its  muscularity  is  most  evident ; 
firm  fibro-cellular  tissue  predominates  in  the  cervix,  with  which  are 
interwoven  here  and  there  bundles  of  narrow,  smooth,  muscular 
fibres ;  and  the  stimulus  of  pregnancy,  which  works  such  changes 
in  the  former  situation,  brings  to  pass  far  slighter  alterations  in  the 
latter. 

At  present,  we  are  too  imperfectly  acquainted  with  the  nature  of 
those  changes  which  I  have  thus  briefly  sketched,  to  be  able  to  say 
exactly  what  influence  is  produced  by  accidents  which  interrupt  the 
course  of  pregnancy  and  originate  the  processes  of  degradation  of 
the  uterine  tissue  prematurely  ;  or  what  results  follow  from  disease 
succeeding  to  delivery  at  the  full  period.  We  may  confidently  hope 
in  time  to  know  more  ;  at  present,  we  have  learned  from  every-day 
experience  that  such  occurrences  interrupt  the  ready  return  of  the 
womb  to  the  size  and  condition  which  are  natural  to  it  in  the  unim- 
pregnated  state ;  that  the  organ  is  apt  to  remain  permanently 
increased  in  size ;  that  this  enlargement  is  often  especially  marked 
in  the  more  lowly  organized  cervix;  that  under  such  circumstances 
the  menstrual  function  is  usually  in  some  respect  or  other  ill  per- 
formed, while  secretions  are  likely  to  be  furnished  from  the  organ 
differing  in  quantity  or  quality  from  those  which  proceed  from  it  in 
a  state  of  health ;  that  the  performance  of  all  the  sexual  functions 
is  very  apt  to  be  attended  by  pain,  that  impregnation  is  less  likely 
to  occur,  and  that,  if  pregnancy  should  take  place,  there  is  very 
great  probability  of  its  coming  to  a  premature  termination. 

This  set  of  symptoms,  however,  or  at  least  many  of  them,  are 
met  with  independent  of  pregnancy  and  its  consequences ;  superven- 
ing sometimes,  indeed,  under  the  influence  of  causes  which  evidently, 
and  in  a  marked  manner,  interfere  with  the  generative  functions, 
but  coming  on  at  other  times  slowly,  and,  as  far  as  we  can  discover, 
without  cause.  How  are  they  to  be  explained  ?  Do  they  proceed 
from  an  invariable  pathological  occurrence,  which  is  present  in 
every  case,  how  wide  soever  may  be  in  other  respects  the  points  of 
difi'erence  between  them — or  are  they  the  indications  of  disordered 
function,  which  may  depend  on  causes  as  various  as  those  which 
produce  vomiting  or  occasion  dyspnoea  ?  The  inquiry  is  manifestly 
an  important  one ;  its  elucidation  will  be  the  object  of  these  Lec- 
tures. It  has  been  said  that  there  is  an  invariable,  or  almost 
invariable,  cause  of  these  symptoms — that,  be  the  remote  occasion 
of  them  what  it  may,  inflammation  and  ulceration  of  the  neck  of  the 


lib  ALLEGED   IMPORTANCE   OF   ULCERATION. 

womb  is  their  immediate  cause — that  the  key  to  the  right  under- 
standing of  uterine  diseases  is  to  be  found  in  the  correct  appreciation 
of  the  importance  of  this  condition ;  and  the  cardinal  point  in  their 
treatment  consists  in  the  adoption  of  means  for  its  cure. 

The  ulcerations  to  which  such  important  results  are  attributed, 
are  for  the  most  part  mere  superficial  abrasions  of  the  epithelium 
investing  the  lips  of  the  os  uteri,  whose  abraded  surface  is  of  a 
vivid  red  colour,  and  finely  granular.  In  other  cases,  in  which  the 
absence  of  epithelium  is  less  complete,  the  surface  seems  beset  by  a 
large  number  of  minute,  superficial,  aphthous  ulcerations,  between 
which  the  tissue  appears  healthy,  or  slightly  redder  than  natural. 
The  ulcerations  of  the  os  uteri  seldom  or  never  present  an  exca- 
vated appearance  with  raised  edges,  as  ulcers  of  other  parts  often 
do ;  but  either  their  surface  is  smooth  or  it  projects  a  little  beyond 
the  level  of  the  adjacent  tissue.  They  are  usually,  but  not  con- 
stantly, of  greater  extent  on  the  posterior  than  on  the  anterior  lip, 
are  sometimes  confined  to  the  former,  but  very  rarely  indeed  limited 
to  the  latter.  They  appear  to  commence  at  the  inner  margin  of  the 
OS  uteri,  whence  they  extend  outwards,  and  sometimes,  though  by 
no  means  invariably,  the  short  extent  of  the  canal  of  the  cervix 
uteri  which  can  be  brought  into  view  by  the  speculum,  appears 
denuded  of  its  epithelium.  The  adjacent  parts  of  the  os  uteri  vary 
considerably  in  their  appearance ;  sometimes  their  natural  pale  rose 
tint  is  preserved  up  to  the  edge  of  the  abrasion,  which  is  marked  by 
a  distinct,  well-defined  line,  while  at  other  times  the  whole  surface 
is  of  a  much  more  vivid  red  than  natural,  and  the  line  of  demarca- 
tion between  the  abraded  and  the  healthy  surface  is  irregular  and 
indistinct,  the  one  encroaching  on  the  other.  The  orifice  of  the 
uterus  is  generally  more  open  than  in  a  state  of  health ;  and  the 
disappearance  of  the  abrasion,  which  always  takes  place  from  the 
periphery  towards  the  centre,  is  accompanied  by  the  gradual  closure 
of  the  previously  patent  orifice.  The  state  of  the  tissue  of  the  os 
and  cervix  varies  ;  sometimes  there  is  a  very  marked  softness  of  the 
parts,  the  condition  resembling  that  of  the  uterus  soon  after  abor- 
tion or  delivery,  while  at  other  times  it  is  much  harder  than  natural ; 
but  it  certainly  is  not  at  all  a  common  occurrence  for  extensive 
abrasion  of  the  os  uteri  to  coexist  with  a  condition  of  the  organ 
such  as  would  seem  healthy  to  the  touch.  The  secretion  from  the 
surface  varies  considerably  in  diff"erent  cases,  and  the  chief  part  of 
the  leucorrhoeal  discharge  from  which  patients  sufi'er  is  derived  from 


STATEMENTS   IN   SUPPORT   OF  IT.  27 

■within  the  canal  of  the  cervix,  or  from  the  cavity  of  the  womb — 
not  from  the  abrasion  itself.  Still,  in  some  instances,  those  espe- 
cially in  which  the  ulceration  presents  a  very  marked  granular 
character,  the  discharge  derived  from  this  source  alone  is  far  from 
inconsiderable.  The  degree  of  sensibility  which  the  ulcerated 
surface  possesses  also  varies  greatly;  now  and  then  the  slightest 
touch  is  extremely  painful ;  but,  in  the  majority  of  cases,  the  ulce- 
rated surface  is  not  more  sensitive  than  the  adjacent  parts,  nor  is 
the  neck  of  the  uterus,  whose  os  is  abraded,  by  any  means  con- 
stantly more  tender  to  the  touch  than  the  same  part  of  an  organ 
entirely  free  from  that  affection. 

Such,  then,  are  the  chief  characters  of  these  ulcerations  or  abra- 
sions of  the  OS  uteri.  I  retain  the  old  name  of  ulceration  in  spite 
of  the  objections  which  have  been  raised  to  it,  because  it  seems  to 
me  better,  as  there  is  no  risk  of  our  being  thereby  led  into  error 
with  reference  to  the  appearances  to  which  that  name  has  been 
applied,  to  accept  for  the  present  the  current  terminology,  and 
to  avoid  those  disputes  about  words  which  are  so  proverbially  fruit- 
less. 

The  really  important  question  is,  whether  ulceration  of  the  os 
uteri  is  to  be  regarded  as  the  first  in  a  train  of  processes  which  are 
the  direct  or  indirect  occasion  of  by  far  the  greater  number  of  the 
ailments  of  the  generative  system ;  or  whether,  on  the  other  hand, 
it  is  to  be  considered  as  a  condition  of  slight  pathological  import- 
ance, and  of  small  semeiological  value — a  casual  concomitant, 
perhaps,  of  many  disorders  of  the  womb,  but  of  itself  giving  rise 
to  few  symptoms,  and  rarely  calling  for  special  treatment  ? 

The  former  opinion,  according  to  which  it  would  be  difficult  to 
overrate  the  pathological  importance  of  ulceration  of  the  os  uteri, 
is  supported  by  the  following  allegations,  which  I  will  endeavour  to 
state  as  briefly,  but  at  the  same  time  as  correctly  as  possible.  It 
is  stated  that  the  mucous  membrane  of  the  cervix  uteri,  by  reason 
of  its  vascularity  and  of  the  abundance  of  mucous  follicles  which 
are  imbedded  between  its  duplicatures,  is  extremely  liable  to  inflam- 
mation ;  and  that  this  predisposition  is  still  further  increased  by 
the  abundant  afllux  of  blood  towards  the  neck  of  the  womb,  as  well 
as  by  the  position  of  that  part  of  the  organ,  and  its  consequent 
exposure  to  irritation  and  injury  from  various  sources.  This  in- 
flammation of  the  cervix  is  said  to  manifest  itself  by  the  secretion 
of  an  abundant  albuminous  matter  from  the  cervical  glands,  and  by 


28  ALLEGED   IMPORTANCE   OF   ULCERATION. 

the  opening  of  the  otherwise  closed  os  uteri — as  also  in  by  far  the 
greater  number  of  cases  by  abrasion  or  ulceration  of  the  os  uteri, 
which  usually  occurs  at  a  very  early  period.  The  cervix  becomes 
swollen  and  congested,  and, it  increases  in  size;  but,  while  in  some 
instances  it  remains  soft  to  the  touch,  even  after  years  of  disease, 
its  substance  becomes  more  frequently  the  seat  of  inflammation, 
lymph  is  effused  into  it,  and  it  is  not  merely  enlarged,  but  indu- 
rated— a  change  which  takes  place  to  a  greater  degree  in  those  who 
have  given  birth  to  children  than  in  the  unmarried  or  the  sterile. 
The  different  extent  of  the  ulceration  is  the  only  cause  assigned  for 
the  presence  of  induration  of  the  cervix  in  one  case,  and  its  absence 
in  another ;  but  the  relation  of  the  two  conditions  does  not  seem  to 
be  by  any  means  invariable.  The  degree  to  which  the  ulceration 
spreads  appears  also  to  be  uncertain ;  in  the  great  majority  of 
cases  it  passes  more  or  less  deeply  into  the  canal  of  the  cervix,  and 
sometimes  occupies  its  whole  extent,  the  internal  os  uteri,  however, 
forming  a  barrier  to  its  further  progress,  and  preventing  almost 
invariably  its  extension  into  the  cavity  of  the  womb.  It  is  then 
inflammation,  with  its  attendant  ulceration  of  the  os  and  cervix 
uteri,  and  usually  with  consecutive  induration  of  its  tissue,  to  which, 
according  to  these  views,  the  sufferings  of  the  patients  are  due ;  and 
all  the  varied  disorders  of  the  uterine  functions,  the  pain,  the  leu- 
corrhoea,  the  hemorrhages,  the  irregular  menstruation,  the  sterility, 
or  the  frequently  occurring  abortions,  are  attributed  to  the  sympa- 
thies of  contiguous  parts  with  that  small  portion  of  the  womb  which 
is  the  seat  of  disease.  Ulceration,  too,  when  once  it  has  occurred, 
is  alleged  to  have  scarcely  any  tendency  to  heal ;  while,  so  long  as 
it  remains,  there  may  perhaps  be  a  lull  in  the  patient's  sufferings, 
and  some  temporary  mitigation  of  her  symptoms ;  but  there  can  be 
no  real  cure  until  the  time  when,  the  period  of  sexual  vigour  having 
expired,  the  organs  which  subserved  it  pass  into  a  common  state  of 
atrophy — while  cure,  even  then,  is  uncertain,  and  the  consequences 
of  disease  outlast,  by  no  means  rarely,  the  uses  of  the  part. 

This  picture  (and  I  have  added  nothing  to  its  colouring)  of  all 
the  ills  which  follow  from  the  seemingly  trivial  ulceration  of  the  os 
uteri,  must  certainly  be  allowed  to  warrant  those  who  drew  it,  if 
only  it  be  a  faithful  portraiture,  in  attaching  great  importance  to 
this  affection — in  trying  to  discover  it  as  early,  to  cure  it  as 
speedily  as  possible. 

As  uterine  pathology  is  simplified  beyond  expectation  by  the  dis- 


CORRECTNESS   OF  THESE   OPINIONS   DOUBTED.  29 

covery  of  an  almost  invariable  cause  of  the  most  diverse  symptoms, 
so  uterine  therapeutics  also  are  made  easy,  according  to  the  writers 
whose  opinions  I  am  relating,  by  one  remedy  being  found  almost 
always  applicable  for  its  cure,  be  the  duration  of  the  disease  or  its 
severity  what  it  may.  If  the  evil  be  slight,  its  removal  will  be 
speedy ;  if  severe,  a  longer  time  will  be  required ;  but  to  modify 
the  vitality  of  the  part  by  caustics  is  the  one  unfailing  indication ; 
and,  this  accomplished,  the  ulceration  and  the  inflammation  and  its 
results  disappear  together,  and  the  sufferings  of  years  are  thus 
almost  infallibly  got  rid  of  in  a  few  weeks,  or,  at  latest,  in  a  few 
months.  There  are,  indeed,  some  cases  of  slight  mischief,  which 
rest,  antiphlogistic  treatment,  and  vaginal  injections  may  cure ;  but 
these  are  rare.  There  are  also  some  circumstances  under  which 
the  local  abstraction  of  blood  may  be  of  service ;  but  what  caustics 
to  use,  how  often  to  repeat  their  application,  how  to  prevent  or  to 
remove  those  inconveniences  which  sometimes  result  from  their 
employment,  are  questions  discussed  as  of  chief  importance ;  since 
to  these  remedies  all  other  local  measures,  as  well  as  all  general 
treatment,  are  but  secondary  and  subservient. 

If  I  thought  that  the  accuracy  of  these  opinions  were  beyond  a 
doubt,  or,  on  the  other  hand,  that  their  entire  fallacy  had  been 
satisfactorily  demonstrated,  I  would  not  now  venture  to  occupy 
your  time  in  conducting  you  over  twice  travelled  ground.  I  believe, 
however,  that  the  profession  is  much  divided,  both  as  to  the  facts 
and  as  to  their  interpretation ;  and  that  it  may,  therefore,  prove  no 
profitless  task  to  endeavour  to  bring  both  to  the  test  of  a  rigid 
inquiry,  and  to  ascertain,  as  far  as  may  be,  where  an  error  has 
been  committed  in  observation,  or  where  wrong  inferences  have 
been  drawn  from  right  observations.  In  doing  this  I  must  crave 
your  indulgence,  and  that  of  all  persons  from  whom  I  may  differ ; 
for  I  am  fully  sensible  how  often  I  may  need  for  myself  that  candid 
interpretation  of  my  statements,  and  that  lenient  judgment  of  my 
errors,  which  I  hope  always  to  manifest  to  others. 

The  evidence  by  which  to  try  the  accuracy  of  those  statements 
that  I  have  endeavoured  fiiithfully  to  set  before  you,  is  very  various 
in  its  kind,  and  also  of  very  various  worth.  It  may,  however  admit 
of  being  arranged  under  four  principal  heads,  to  each  of  which,  in 
succession,  our  attention  must  be  directed. 

In  the  first  place,  we  may  inquire  how  far  these  statements  receive 


30  PLAN   OF   INQUIRY  INTO   THESE 

confirmation  from  what  we  know  of  the  anatomy  and  physiology  of 
the  uterus  in  a  state  of  health. 

Still,  what  answer  soever  we  may  receive  to  this  question,  it 
cannot,  from  its  very  nature,  be  conclusive ;  it  may  render  a  certain 
occurrence  probable  or  improbable,  may  substantiate  or  disprove 
the  correctness  of  certain  opinions  or  explanations,  but  cannot 
invalidate  the  evidence  of  positive  facts. 

In  the  second  place,  we  may  try  to  ascertain  whether  examination 
of  the  dead  body  shows  the  morbid  conditions  of  the  os  uteri  which 
have  been  described  to  be  frequent  or  rare,  slight  or  extensive;  and 
we  may  also  endeavour  to  make  out  what  connection  subsists  be- 
tween ulceration  of  the  mucous  membrane  of  the  os  and  cervix  uteri, 
and  other  changes  in  the  tissue  of  the  organ. 

It  must,  however,  be  borne  in  mind  that  many  evidences  of  dis- 
ease, such  as  are  very  obvious  during  life,  may  be  greatly  obscured, 
or  may  even  entirely  disappear  after  death :  and  further,  that  uterine 
disorders  of  the  class  which  we  are  considering,  though  exceedingly 
painful,  and  seriously  interfering  with  a  woman's  health  and  com- 
fort, are  yet  not  of  a  kind  to  prove  the  direct  occasion  of  her  death. 
Evidence  derived  from  this  source  will  therefore  be  open  to  the 
objection  that  it  understates  both  the  frequency  and  the  importance 
of  these  diseases. 

We  may  inquire,  in  the  third  place,  whether  there  is  any  condi- 
tion in  which  ulceration  of  the  os  uteri  comes  under  our  notice 
unconnected  with  other  disease,  and  with  such  circumstances  as  to 
admit  readily  of  our  observing  its  characters  and  watching  its  course 
and  consequences.  Such  a  state  of  things  presents  itself  to  us 
often  in  the  case  of  the  procident  uterus,  since  the  irritation  to 
which  the  displaced  organ  is  unavoidably  exposed  has  the  almost 
invariable  effect  of  producing  ulceration  of  the  surface  of  the  os 
uteri,  and  of  the  immediately  adjacent  parts  of  the  organ. 

But,  whatever  conclusions  we  may  deduce  from  this  source  are 
open  to  all  the  objections  inseparable  from  analogical  reasoning. 
The  probabilities  of  certain  occurrences  taking  place  in  the  uterus 
under  other  circumstances  may  be  increased  or  weakened ;  but  the 
evidence  still  falls  short  of  absolute  proof,  either  of  the  affirmative 
or  of  the  negative  of  the  question. 

The  fourth  and  most  important  inquiry  of  all  concerns  the  fre- 
quency of  these  ulcerations  of  the  os  uteri  under  those  circum- 
stances in  which  they  ordinarily  come  under  our  notice,  and  call, 


OPINIONS   PROPOSED.  31 

or  are  supposed  to  call,  for  our  interference.  This  inquiry,  how- 
ever, must  include  not  only  the  frequency  of  ulceration,  but  also 
the  conditions  generally  associated  -with  it,  and  the  symptoms  to 
which  it  commonly  gives  rise.  If  the  alleged  symptoms  of  ulcera- 
tion are  found  to  be  not  rarely  present  without  ulceration,  and  if 
ulceration  is  discovered  even  where  there  are  no  symptoms ;  or  if, 
in  the  same  case,  the  ulceration  may  vary  in  extent,  with  no  corre- 
sponding change  in  the  symptoms  ;  if  an  indurated  state  of  the 
cervix  exists  without  ulceration,  and  ulceration  even  of  long  stand- 
ing, without  induration — the  conclusion,  especially  if  supported  by 
the  answers  obtained  to  our  previous  inquiries,  seems  to  me  irre- 
sistible that  the  importance  of  inflammation  of  the  cervix  and  of 
ulceration  of  the  os  uteri  has  been  overstated ;  that  they  are  not 
the  cause  of  all  the  symptoms  which  they  have  been  alleged  to 
occasion,  and  that,  in  the  treatment  of  uterine  disease,  many  other 
considerations  must  influence  us  more  than  the  mere  removal  of 
ulceration  of  the  orifice  of  the  womb. 

If  this  were  proved,  it  would  still  remain  for  us  to  consider 
whether,  in  any  case,  we  may  fairly  look  upon  the  ulceration  of  the 
OS  uteri  as  a  symptom  calling  for  distinct  recognition  and  special 
treatment.  There  are,  I  am  aware,  some  persons  of  deserved 
repute  who  will  look  upon  this  inquiry  as  superfluous ;  but,  for  my 
own  part,  I  do  not  conceive  that,  even  if  we  arrived  at  a  conclusion 
never  so  unfavourable  to  the  supposed  great  importance  of  ulcera- 
tion of  the  OS  uteri,  we  should  be  thereby  entitled  to  regard  its 
symptoms  as  a  mere  delusion,  its  very  existence  as  little  more  than 
a  figment  of  the  fancy. 

I.  It  was  observed  that,  in  the  first  place,  something  of  additional 
probability  or  improbability  might  be  imparted  to  those  views  which 
we  propose  to  investigate  by  what  anatomy  and  physiology  teach 
us  of  the  uterus  and  its  functions.  Now  it  is  alleged,  as  one  reason 
for  the  liability  of  the  cervix  uteri  to  affections  from  which  the  body 
of  the  organ  is  comparatively  free,  that  it  receives  a  greater  amount 
of  blood,  that  it  is  endowed  with  a  higher  degree  of  vitality  than 
other  parts  of  the  organ.  But  surely  this  statement  is  erroneous-; 
and  it  sufiices  to  examine  the  healthy  uterus  for  any  one  to  satisfy 
himself  of  the  smaller  vascularity  of  the  neck  than  of  the  body  of 
the  womb.  It  is  the  body  which  chiefly  grows  as  the  period  of 
puberty  approaches,  it  is  the  body  to  which  the  great  determination 
of  blood  takes  place  during  each  menstrual  period,  and  from  the 


32  PHYSIOLOGICAL   FACTS   UNFAVOURABLE   TO 

lining  membrane  of  the  body  that  the  menstrual  flux  is  poured  out. 
The  looser  tissue,  the  large  vessels,  the  congested  mucous  membrane 
characteristic  of  the  menstruating  uterus,  are  limited,  or  nearly  so, 
to  the  body  and  fundus  of  the  organ ;  and  it  is  the  epithelium  of 
its  cavity,  not  that  of  the  neck  of  the  womb,  which  is  abundantly 
intermixed  with  the  menstrual  fluid.  When  conception  takes  place, 
it  is  the  body  of  the  uterus  which  first  and  chiefly  enlarges,  its 
mucous  membrane  which  becomes  developed  to  the  decidua,  ita 
tissue  which  grows  and  is  metamorphosed  into  muscular  fibre; 
while  the  changes  in  the  membrane  of  the  cervix  are  limited  to  an 
increased  activity  of  its  mucous  follicles,  and  the  alterations  in  its 
substance  to  an  increased  formation  of  fibro-cellular  tissue,  with  a 
comparatively  scanty  growth  of  muscular  fibre.  After  delivery,  the 
retrograde  processes  are  much  more  striking  in  the  body  than  in  the 
neck  of  the  womb.  The  mucous  membrane  of  the  cervix,  stretched 
during  pregnancy  till  the  folds  which  it  presented  in  the  unimpreg- 
nated  condition  are  obliterated,  resumes  once  more  its  former  pli- 
cated arrangement,  while  that  of  the  body  is  detached  and  repro- 
duced again  and  again  before  the  organ  reverts  to  its  former  state. 
The  cervix  is  less  sensitive  than  the  body  of  the  uterus :  the  sound 
which  passes  along  the  canal  of  the  former  almost  unfelt,  generally 
finds  the  lining  of  the  uterine  cavity  acutely  sensitive.  The  cervi- 
cal canal  has  been  forcibly  dilated,  it  has  been  incised ;  the  tissue 
of  the  cervix  has  been  burnt  with  the  strongest  caustics,  or  with  the 
actual  cautery,  or  portions  of  it  have  been  removed  by  the  knife, 
generally  with  no  injurious  consequence ;  often  with  so  slight  a 
degree  of  constitutional  disturbance,  or  even  of  local  sufi'ering,  as  to 
surprise  those  who  advocate,  little  less  than  those  who  condemn, 
such  proceedings. 

But,  if  structurally  so  lowly  organized — if  physiologically  of  such 
secondary  importance — if  so  much  less  subject  than  the  body  of  the 
uterus  to  alterations  in  its  intimate  structure — and  if  so  compara- 
tively insensible  even  to  rude  modes  of  therapeutical  interference — 
it  certainly  does  appear  to  me  that  the  assumption  that  some  slight 
abrasion  of  the  mucous  membrane  covering  this  part  is  capable  of 
causing  a  list  of  ills  so  formidable  as  are  attributed  to  it,  ought  to 
rest  for  its  support  upon  some  other  and  stronger  foundation  than 
any  inference  fairly  deducible  from  anatomical  or  physiological 
data. 

II.  We  will  now,  however,  inquire,  in  the  second  place,  into  the 


SUPPOSED  IMPORTANCE  OF  ULCERATION.  33 

nature  of  the  evidence  on  this  subject  which  can  be  deduced  from 
anatomical  investigation.  At  first  sight,  indeed,  it  seems  somewhat 
strange  that  those  who  believe  in  the  frequency  and  importance  of 
ulceration  of  the  os  uteri,  have  made  no  attempt  to  demonstrate 
those  facts  by  examination  of  the  body  after  death ;  while  the  only 
persons  who  have  appealed  to  its  results,  allege  this  condition  to  be 
very  rare  and  very  trivial.  It  must  not  be  forgotten,  however, 
that  appearances,  the  most  striking  characters  of  which  consist  in 
increased  vascularity,  and  in  that  vital  turgescence  which  disap- 
pears soon  after  life  has  departed,  cannot  be  expected  to  be  very 
marked  some  days  after  death.  Indeed,  no  one  who  has  felt  the 
large  firm  growth  of  cauliflower  excrescence  sprouting  from  the 
neck  of  the  womb  during  life,  and  has  contrasted  with  it  the  small 
bundle  of  collapsed  filaments  which  are  all  that  remains  of  it  after 
death,  but  must  be  prepared  to  admit  that  a  condition  of  the  os 
uteri  very  obvious  during  life,  and  the  cause  of  very  grave  symp- 
toms, may  yet  leave  but  very  few  traces  after  death. 

Besides,  it  must,  I  think,  be  acknowledged  that  the  data  on  which 
the  negative  assertions  of  morbid  anatomists  rest  are  not  so  fault- 
less as  to  command  by  any  means  implicit  confidence.  Neither  M. 
Lair,^  who,  in  1828,  gave  some  of  the  results  of  the  inspection  of 
500  female  subjects,  nor  M.  Pichard,^  who,  in  1846,  added  to  them 
the  results  of  300  more,  gives  the  least  information  as  to  when, 
where,  or  how  these  examinations  were  made.  They  do  not  even 
state  the  age  of  any  of  the  subjects,  nor  afibrd,  either  directly  or 
indirectly,  the  slightest  guarantee  that  these  inspections  were  made 
with  due  care ;  on  the  contrary,  indeed,  the  appearances  observed 
are  described  so  loosely  that,  with  reference  to  many  of  them,  it  is 
by  no  means  easy  to  determine  their  exact  nature.  Of  this  want 
of  exactness  no  better  proof  can  be  given  than  the  fact  that  while 
M.  Lair  discovered  but  12  ulcerations  of  the  os  uteri  out  of  500 
examinations,  and  M.  Pichard  but  5  out  of  300  more,  the  latter 
mentions  that  in  54,  or  rather  more  than  a  sixth  of  his  cases,  a 
granular  state  of  the  os  uteri  was  present ;  while  M.  Lair  makes  no 
reference  to  his  having  ever  met  with  such  a  condition.      But  I 

1  Nouvelle  Methode  de  Traitement  des  Ulceres,  etc.,  de  I'Uterus,  8vo.,  Paris,  2d 
edit.  1828. 

2  Des  Abus  de  la  Cauterisation,  etc.,  dans  les  maladies  de  la  matrice,  8vo.,  Paris,. 
1846. 

3 


34  RESULTS  OF 

need  say  no  more  about  these  two  writers,  since  any  attempt  to 
reconcile  their  statements  leaves  us  in  hopeless  bewilderment,  satis- 
fied of  but  one  thing,  namely,  that  facts  so  collected  and  so  arranged 
are  available  for  no  useful  purpose. 

I  fear  that  a  very  similar  statement  must  be  made  with  reference 
to  the  facts  bearing  on  this  subject  which  have  been  collected  in  our 
own  country.  Not  only  is  there  no  evidence  of  their  having  been 
observed  with  that  minute  care  which  is  needed  to  render  them 
thoroughly  trustworthy ;  but,  with  reference  to  many  hundreds  of 
the  cases,  if  not  to  all,  conclusions  have  been  drawn  as  to  the 
frequency  of  certain  morbid  conditions  of  the  uterus,  from  the 
examination  alike  of  the  infant  of  a  few  weeks  old  and  of  the  old 
woman  of  seventy;  an  oversight,  to  call  it  by  the  mildest  term, 
which  renders  any  results  deduced  from  such  data  worse  than 
useless. 

It  is  idle  to  expect  to  meet  with  frequent  indications  of  uterine 
disease  before  the  generative  organs  have  arrived  at  maturity  suf- 
ficient to  commence  the  performance  of  their  functions;  while, 
after  the  time  of  sexual  vigour  has  passed,  the  only  diseases  we  are 
likely  to  find  are  such  as  commenced  at  an  earlier  period,  or  such 
as  may  be  incidental  to  the  mere  tissue  of  the  organ,  wholly  inde- 
pendently of  the  function  which  it  once  performed. 

The  question  then  is,  with  what  frequency,  and  associated  with 
what  other  changes,  do  we  meet  with  indications  of  inflammation 
and  ulceration  of  the  os  and  cervix  uteri,  in  the  bodies  of  women 
after  puberty,  and  especially  during  the  period  of  sexual  activity  ? 
My  own  observations,  which  amount  only  to  62,  are  too  few 
conclusively  to  settle  this  inquiry  ;  though  I  cannot  but  hope  that 
the  care  with  which  they  were  made  may  compensate  to  some 
extent  for  the  smallness  of  their  number,  and  that  they  may  serve 
at  least  to  indicate  the  side  towards  which  the  weight  of  evidence 
inclines.  Each  examination  was  recorded  according  to  a  printed 
form,  on  which  were  specified  for  separate  notice  the  dimensions  of 
the  uterus,  the  condition  of  the  os,  the  length  and  breadth  of  the 
cervix  uteri,  the  size  of  the  uterine  cavity,  the  thickness  of  the  walls 
of  the  organ,  and  so  on ; — points  some  of  which  were  of  practical 
interest,  while  the  enforced  attention  to  others  had  at  least  this 
advantage,  that  it  prevented  anything  from  being  overlooked. 

The  uteri  were  taken  from  patients  who  died  in  the  medical 
wards  of  St.  Bartholomew's  Hospital  of  other  than  uterine  disease. 


PERSONAL  OBSERVATION.  35 

Of  the  total  number,  13  were  above  forty-five  years  of  age,  the 
remaining  49  between  the  years  of  fifteen  and  forty-five.  Concern- 
ing all  of  the  former  class,  and  30  of  the  latter,  making  a  total  of 
43,  it  was  either  known  with  certainty,  or  concluded  with  great 
probability,  that  they  were  married,  or  had  had  sexual  intercourse ; 
the  remaining  19  were  believed  to  be  virgins. 

The  subjoined  table  shows  the  general  results  of  the  examination 
of  the  uterus  in  these  cases,  and  the  relations  borne  to  ulceration 
of  the  OS  uteri  by  the  more  important  morbid  appearances.^ 

TABLE 

Showing  the  chief  results  of  the  examination  of  62  uteri: 


Uterus  healthy  in      . 
'*      diseased  in    . 

Ulceration  of  os  uteri  in       . 
"         existed  alone  in  . 
'*         with  diseased  lining  of  uterus  in 
"         with  induration  of  walls  of  uterus  in 
Induration  of  walls  of  uterus,  without  ulceration  of  os 
Disease  of  lining  of  uterus,  without  ulceration  of  os 


.  29 

.  17 
11 
3 

3—17 

.  6 

.  7 


Total  of  diseased  uteri,  29 

The  OS  uteri  was  abraded  in  1  of  the  subjects  above  45  years  of 
age  ;  and  the  lining  of  its  interior  was  diseased  in  5  of  that  number. 
In  11  of  the  19  patients,  all  under  45  years  old,  who  were  virgins, 
the  uterus  was  perfectly  healthy ;  in  8  it  presented  some  sign  or 
other  of  disease.  This  consisted  5  times  in  slight  abrasion  of  the 
OS  uteri,  which  existed  alone  in  3  cases ;  but  was  associated  in  the 
other  2  with  some  morbid  state  of  the  interior  of  the  womb.  Twice 
the  interior  of  the  uterus  was  the  only  part  afi'ected  ;  and  once  the 
uterine  walls  were  much  harder  than  natural. 

There  is  certainly  something  at  first  not  a  little  startling  in  the 
result  at  which  we  arrive,  that  the  womb  was  found  in  a  perfectly 
healthy  condition  in  little  more  than  the  half  of  62  women,  none  of 
whom  died  of  uterine  disease,  nor  were  supposed  to  be  suffering 
from  any  grave  uterine  ailment.  But  it  may,  it  ought  indeed  to  be, 
asked,  what  is  the  value  of  these  appearances?      Some  of  them 

'  In  the  above  table,  and  in  the  general  statements  of  the  state  of  the  uterus,  no 
notice  is  taken  of  morbid  conditions  of  the  uterine  appendages,  nor  of  those  affections 
of  the  womb  (such,  for  instance,  as  fibrous  tumors)  which  obviously  stand  in  no 
necessary  relation  to  inflammation  of  the  organ,  or  to  ulceration  of  its  orifice. 


86  ULCERATION  GENERALLY  SLIGHT. 

may  be  of  little  moment,  and  the  very  frequency  of  their  occurrence, 
instead  of  substantiating  the  opinion  that  they  are  of  great  import- 
ance, rather  militates  against  that  supposition.  When  ulceration  of 
the  OS  uteri  was  first  observed,  it  was  natural  enough  to  attribute  to 
it  many  symptoms,  and  to  refer  to  its  influence  many  structural 
changes.  But  what  if  such  ulceration  be  found  to  be  usually  very 
limited  in  extent,  and  so  superficial  as  to  be  unassociated  with 
changes  in  the  basement  membrane  of  the  afi'ected  surface,  and 
exercising  so  little  influence  on  the  state  of  the  uterus  in  general,  as 
to  be  unconnected  in  a  large  number  of  instances  with  changes 
either  in  the  interior  of  the  womb,  or  in  its  substance ;  while  indu- 
ration of  the  uterine  tissue  and  disease  of  the  lining  membrane  of 
the  womb  are  found  independently  of  it,  or  of  each  other  ?  Should 
such  appear  to  be  the  case,  it  will,  I  think,  be  rendered  in  the  highest 
degree  probable  that  this  abrasion  of  the  os  uteri  has  not  the  long 
train  of  sequences  which  have  been  supposed  to  follow  it,  but  that 
it  is  of  comparatively  small  pathological  import;  that  it  may  be 
found  to  vary  under  the  influence  of  comparatively  trifling  causes ; 
and  not  unfrequently  to  be  dependent  on  functional  disorder  of  the 
uterus,  just  as  the  mucous  membrane  of  the  tongue  and  mouth 
betrays  the  disturbance  of  the  digestive  system ;  that  it  may,  in 
short,  be  the  consequence,  and  sometimes  the  index,  but  rarely  the 
occasion,  of  the  ailments  with  which  it  is  associated. 

Abrasion  of  the  os  uteri  was  observed  in  11  instances  unconnected 
with  any  other  morbid  condition  of  the  womb.  In  6  cases  it  was 
extremely  slight,  afi"ecting  just  the  edges  of  the  os  uteri,  but  not 
extending  for  more  than  a  line  in  breadth  ;  the  mucous  membrane 
lining  the  canal  of  the  cervix  was  in  all  of  these  instances  quite 
pale,  but  twice  the  lining  of  the  uterine  cavity  was  of  a  brighter  red 
than  natural.  In  the  other  5  cases,  the  abrasion,  though  retaining 
the  same  character,  was  more  extensive ;  once  the  abraded  surface 
presented  a  finely  granular  aspect,  but  was  quite  uniform ;  but  in 
the  other  four  cases  it  had  an  uneven  worm-eaten  appearance, 
probably  due  to  a  partial  destruction  of  the  papillae  which  beset  the 
OS  uteri.  ^  In  4  of  these  cases  the  abrasion  extended  for  a  short 
distance  up  the  canal  of  the  cervix,  while  once  it  was  limited  to  that 
exclusively,  the  lips  of  the  os  being  perfectly  pale  and  healthy,  and 

'  As  in  the  delineation,  by  Drs.  Hassall  and  Tyler  Smith,  in  vol.  xxxv.  of  the 
Medico-Chirurgical  Transactions. 


INDURATION  OF  CERVIX  UTERI.  87 

the  mucous  membrane  of  the  cervix  unaltered,  except  along  a  strip 
a  third  of  an  inch  in  breadth  by  an  inch  in  length,  where  the  pos- 
terior wall  was  abraded.  In  3  of  the  above  4  instances  there  was 
some  increase  of  vascularity  in  the  mucous  membrane  of  the  cervix, 
which  on  one  occasion  extended  for  nearly  half  an  inch  up  its  canal ; 
and  once  this  condition  was  very  marked,  and  the  mucous  membrane 
appeared  swollen  and  infiltrated,  but  in  no  other  case  was  there  any 
appearance  of  thickening  of  the  membrane  either  at  the  seat  or  in 
the  immediate  neighbourhood  of  the  abrasion. 

It  is  alleged,  as  we  have  already  seen,  that  in  the  great  majority 
of  instances  ulceration  of  the  os  uteri  gives  rise  to  induration  of  the 
cervix,  the  result  of  the  extension  of  inflammation  to  it,  and  of  the 
efi'usion  of  plastic  lymph  into  its  structure,  which  lymph  comes  by 
degrees  to  be  more  and  more  organized.  This  description,  however, 
of  the  manner  in  which  induration  of  the  cervix  uteri  takes  place  is 
purely  imaginary ;  there  are  no  observations  whatever  bearing  on 
the  subject,  and  the  difficult  task  of  tracing  the  results  of  chronic 
inflammation  in  any  tissue  is  obstructed  by  so  many  special  impedi- 
ments in  the  case  of  the  uterus,  that  it  will  probably  be  long  before 
we  shall  be  in  a  position  to  speak  with  any  measure  of  certainty 
concerning  it.  The  account  of  the  process  by  which  induration  of 
the  cervix  uteri  is  produced  may  possibly  be  correct,  but  at  any 
rate  it  is  not  proven ;  and  few  things  have  so  retarded  the  advance 
of  medical  knowledge  as  the  accepting  some  plausible  hypothesis  as 
if  it  were  a  statement  of  well-ascertained  facts,  and  then  proceeding 
to  reason  from  it  as  if  from  some  secure  basis. 

Under  what  circumstances  is  induration  of  the  uterine  tissue  met 
with,  and  in  connection  with  what  other  changes  in  the  organ  ?  It 
existed  in  9  cases ;  in  5  of  which  it  was  not  associated  with  any 
other  disease  of  the  uterine  substance ;  in  3  it  coexisted  with  ulcera- 
tion of  the  OS  ;  and  in  1  with  a  morbid  state  of  the  interior  of  the 
uterus.  In  an  unmarried  girl,  aged  eighteen,  who  died  of  capdiac 
dropsy,  the  tissue  of  the  fundus,  and  of  the  upper  half  of  the  body 
of  the  uterus,  presented  its  usual  characters;  but  about  half-way 
down  the  body  of  the  organ  there  began  a  strip  of  a  dead  yellow 
colour,  and  much  denser  texture,  resembling  fibro-cartilage  or  the 
elastic  coat  of  an  artery.  The  dense  tissue  lay  immediately  beneath 
the  lining  membrane  of  the  uterus,  and  being  at  first  only  one  line 
in  thickness,  increased  in  width  till  it  came  to  constitute  the  whole 
thickness  of  the  cervix  uteri.     In  the  case  of  another  patient,  aged 


38  '  OTHER  APPEARANCES  DISCOVERED 

forty-seven,  a  similar  condition  was  met  with  in  the  body  of  the 
uterus,  but  scarcely  at  all  involved  the  cervix ;  and  in  the  three 
other  cases,  in  all  of  which  the  women  were  under  thirty  years  old, 
the  cervix  uteri  alone  was  affected,  being  white,  hard,  creaking 
under  the  knife,  and  seeming  under  the  microscope  to  be  composed 
of  an  extremely  dense  fibrous  tissue. 

It  appears,  then,  that  most  marked  induration  of  the  tissue  of  the 
cervix,  and  of  part  of  the  body  of  the  womb,  may  exist  where  there 
is  no  other  trace  of  inflammation,  either  past  or  present.  It  may 
also  occur  in  connection  with  inflammation  and  ulceration  of  the 
lining  membrane  of  the  uterine  cavity.  In  a  woman  who  died  at 
the  age  of  fifty-six,  about  a  third  of  the  thickness  of  the  wall  both 
of  the  body  and  of  the  neck  of  the  womb  was  exceedingly  firm,  and 
creaked  under  the  knife.  Abundant  glairy  secretion  from  the 
cervical  glands,  and  some  want  of  transparency  of  its  lining  mem- 
brane, were  the  only  unusual  conditions  of  the  interior  of  the  uterine 
neck  ;  but  the  cavity  of  the  organ  Contained  a  copious  purulent 
secretion  mixed  with  blood ;  its  mucous  membrane  was  thickened, 
vascular,  and  destitute  of  polish,  and  about  the  middle  of  the  pos- 
terior wall  completely  destroyed,  leaving  the  substance  of  the  womb 
beneath  uneven,  rather  soft,  and  presenting  the  appearance  of  a 
granulating  surface. 

Ulceration  of  the  os  uteri,  and  induration  of  the  uterine  walls, 
were  associated  together  in  three  instances.  On  one  occasion  the 
ulceration  was  but  slight,  and  the  interior  of  the  cervix  extremely 
pale,  though  there  was  great  injection  of  the  lining  of  the  uterine 
cavity.  In  this  instanfce  the  cervical  wall  was  much  indurated, , 
that  of  the  body  of  the  uterus  rather  less  so.  Extreme  induration 
of  the  cervix  existed  in  one  case  where  there  was  rather  extensive 
ulceration  of  the  os  uteri ;  and  in  this  instance  the  cervix  was  con- 
siderably hypertrophied.  The  patient  from  whom  this  uterus  was 
taken  had  been  under  my  care  for  some  years^  previously,  suffering 
from  symptoms  such  as  Gooch  describes  under  the  name  of  irritable 
uterus ;  her  sufferings  had  been  most  severe,  and  the  enlargement 
of  her  womb  most  considerable  at  a  time  when  there  was  no  abra- 
sion of  its  orifice.  In  one  case  only,  in  which  there  was  consider- 
able induration  of  the  cervix,  there  was  a  distinct  line  of  congestion, 
about  half  a  line  in  depth,  between  the  ulcerated  surface  and  the 
pale  tissue  of  the  indurated  cervix. 

In  10  cases,  the  condition  of  the  lining  membrane  of  the  uterine 


MORE  SERIOUS  THAN  ULCERATION.  39 

cavity  deviated  from  that  which  characterizes  it  in  a  state  of  health. 
Thrice  this  state  of  the  interior  of  the  womb  coexisted  with  ulcera- 
tion of  its  orifice  of  moderate  extent,  and  presenting  its  ordinary 
appearance ;  but  in  the  remaining  7  instances  the  os  uteri  was  per- 
fectly healthy.  In  7  of  the  10  cases  the  uterine  mucous  membrane 
was  vividly  injected,  so  as  to  present  a  bright  rose  tint,  and  was 
more  or  less  swollen  and  softened.  Once  very  extensive  disease  of 
the  lining  membrane  of  the  uterine  cavity,  probably  of  a  tuberculous 
character,  was  discovered  in  the  body  of  a  woman  fifty-six  years  old. 
In  a  second  case,  in  which  the  patient  was  stated  to  have  had  a 
copious  leucorrhoeal  discharge,  and  to  have  complained  of  pain  and 
of  a  sense  of  heat  at  the  lower  part  of  the  abdomen,  the  intensely 
red  mucous  membrane  of  the  uterine  cavity  presented  an  almost 
gelatinous  appearance,  and  looked  not  unlike  decidua.  In  this 
instance,  though  there  was  some  ulceration  of  the  os,  yet  the  lining 
membrane  of  the  cervix  was  quite  pale ;  no  secretion  occupied  its 
canal,  and  the  tissue  of  the  uterus  was  quite  healthy.  In  a  third 
case  a  small  patch  of  ecchymosis  was  present  beneath  the  lining  of 
the  uterine  cavity ;  and  in  a  fourth,  where  the  patient  had  not 
menstruated  for  five  months,  the  lining  membrane,  though  of  a 
pinkish  colour,  had  lost  its  polish,  and  looked  more  like  an  injected 
serous  membrane  than  like  the  mucous  lining  of  the  womb. 

It  has  not  been  from  want  of  perception  of  the  hopeless  tedious- 
ness  of  such  details,  that  I  have  ventured  to  take  up  your  time  so 
long  with  an  account  of  the  morbid  appearances  of  the  uterus,  ob- 
served in  these  cases.  Many,  probably  very  many,  of  these  condi- 
tions ought  to  be  classed  with  pseudo-morbid,  rather  than  with 
pathological  appearances ;  but  the  data  at  present  fail  us  for  dis- 
tinguishing with  accuracy  the  one  from  the  other.  But,  be  this  as 
it  may,  it  is  yet  abundantly  evident  that  many  of  them  imply  de- 
viations from  a  healthy  state  more  considerable  than  the  trifling 
abrasion  or  ulceration  of  the  os  uteri,  -vVhich  existed  on  several 
occasions.  We  have  seen  that,  in  by  far  the  majority  of  cases,  the 
ulceration,  when  present,  was  not  merely  trifling  in  extent,  but  that 
it  had  not  given  rise  to  so  much  irritation  of  the  neighbouring 
tissues  as  to  produce  any  appreciable  congestion  of  the  mucous 
membrane  in  its  vicinity ;  while  the  changes  in  the  uterine  sub- 
stance alleged  to  depend  upon  it  were  often  er  present  without  than 
in  connection  with  it ;  and,  moreover,  none  of  the  alterations  about 


40       CONCLUSION  UNFAVOURABLE  TO  ITS  IMPORTANCE. 

the  OS  and  cervix  of  the  womb  were  so  considerable  as  those  which 
were  apparent  in  its  cavity. 

Other  evidence,  indeed,  must  be  adduced  than  that  which  ana- 
logical reasoning  from  the  facts  of  physiology  has  suggested,  or 
than  that  which  examinations  after  death  have  furnished,  before 
we  shall  be  entitled  to  reject  the  opinion  that  inflammation  of  the 
cervix,  and  ulceration  of  the  os  uteri,  are  occurrences  of  very 
serious  pathological  importance — the  occasion  of  ijearly  all  the  ills 
which  affect  the  physical  well-being  of  woman.  That  other  evidence 
must  be  reserved  till  the  next  Lecture  ;  but  yet,  unless  I  have 
altogether  failed  in  my  endeavours,  the  question  is  not  left  to-day 
quite  where  it  was  before ;  since,  tempting  though  this  hypothesis 
may  be,  and  numerous  the  difficulties  which  it  may  appear  to  solve, 
we  yet  have  found  that  it  is  opposed  by  the  facts  of  physiology, 
unsupported,  to  say  the  least,  by  the  results  of  anatomical  investi- 
gation. 


LECTURE    II. 

Inquiry  continued.  III.  Course  and  consequences  of  ulceration  of  the  prolapsed 
uterus;  they  do  not  seriously  disorder  the  uterine  functions,  or  alter  its  struc- 
ture. IV.  Kesults  of  clinical  observation.  Examination  of  prostitutes  suffering 
from  gonorrhoea  or  syphilis  shows  susceptibility  of  cervix  uteri  to  have  been 
over-estimated.  Question  considered  with  reference  to  importance  of  ulceration 
when  present.  Three  different  solutions  of  it  suggested.  Tests  by  which  it  is 
proposed  to  determine  it.     Nature  of  materials  for  this  purpose  stated. 

Influence  of  ulceration  of  os  on  fecundity  inconsiderable — Its  occurrence  connected 
with  activity  of  sexual  functions,  as  shown  by  patient's  age  and  alleged  cause  of 
illness.  Similarity  in  these  respects  to  cases  where  ulceration  is  absent  shown 
further  by  duration  of  symptoms,  by  disorder  of  menstruation,  by  occurrence  of 
leucorrhoea,  by  complaints  of  pain,  and  in  the  main  by  condition  of  the  uterus. 

Further  examination  into  relation  of  ulceration  of  the  os  uteri  to  induration  of  its 
cervix  shows  it  not  to  be  constant,  nor  bearing  any  necessary  relation  in  degree. 

General  inferences  from  inquiry  unfavourable  to  first  two  solutions  of  question  con- 
cerning importance  of  ulceration  of  os  uteri ;  and  consequently  to  opinion  that 
it  is  a  condition  of  great  importance. 

Mr.  President — 

Sir  :  The  facts  and  considerations  which  I  had  the  honour  to 
submit  to  you  in  my  former  Lecture,  were,  as  you  will  remember, 
not  brought  forward  as  conclusive  of  the  question  that  they  were 
intended  to  elucidate.  They  seemed,  however,  to  raise  a  presump- 
tion against  rather  than  in  favour  of  the  opinion,  that  inflammation 
of  the  cervix  and  ulceration  of  the  orifice  of  the  uterus  are  condi- 
tions of  great  pathological  importance  ;  and  at  any  rate  to  warrant 
us  in  scrutinizing  very  closely  such  other  evidence  as  may  be  ad- 
duced to  substantiate  its  correctness. 

I  purpose  to-day  to  advance  further  in  this  investigation ;  to 
abandon  for  the  present  physiological  reasoning,  to  lay  aside  the 
scalpel  of  the  anatomist,  and  to  learn  what  we  may  of  this  subject 
from  the  study  of  the  living. 

The  complex  character  of  disease  offers  one  great  impediment  to 
our  thoroughly  understanding  it :  the  having  surmounted  this  dif- 
ficulty constitutes  the  great  difference  between  the  experienced 


42  CHARACTERS  OF  ULCERATION  OF 

physician  and  the  novice.  In  the  matter  of  uterine  disease,  we  are, 
I  fear,  all  novices  ;  and  it  was  this  consideration  which  induced  me 
to  propose  that  we  should,  if  possible,  study — 

III.  As  the  third  point  m  this  inquiry,  ulceration  of.  the  os 
uteri,  under  some  condition  in  which  it  presents  itself  to  our  notice 
unconnected  with  other  disease,  and  with  such  circumstances  as  to 
admit  readily  of  our  observing  its  characters,  and  noting  its  course 
and  consequences. 

Fortunately,  the  opportunities  for  this  study  abound ;  and  in 
almost  every  woman  whose  uterus  has  become  prolapsed  beyond 
the  external  parts,  we  may  observe  the  effects  which  ulceration  of 
the  OS  uteri  commonly  produces,  the  symptoms  to  which  it  gene- 
rally gives  rise  ;  we  can  trace  it  in  its  progress,  can  watch  it  for 
weeks  or  months  together,  and  see  what  it  has  led  to  where  it  has 
existed  even  for  years. 

A  previously  healthy  woman  leaves  her  couch  too  soon  after  her 
delivery,  while  her  vagina  is  still  lax,  and  its  power  of  supporting 
the  uterus  is  perhaps  still  further  diminished  by  laceration  of  the 
perineum.  The  retrograde  process  by  which  the  bulk  of  the  womb 
should  be  eventually  reduced  to  its  former  dimensions  is  still  in- 
complete ;  while  the  outstretched  uterine  ligaments  have  not  had 
time  to  contract  to  their  former  size,  nor  to  recover  their  former 
resiliency.  The  heavy  uterus,  thus  ill-supported,  sinks  down  in  the 
pelvis,  approaches  by  degrees  nearer  and  nearer  to  the  external 
parts,  and  at  length  occasionally  projects  beyond  them  ;  and  in  the 
course  of  a  few  weeks  or  months  the  occasional  prolapse  becomes 
habitual.  At  first,  it  is  only  a  portion  of  the  womb  which  thus  pro- 
jects ;  but  often  the  whole  uterus  comes  in  the  course  of  time  to 
hang  externally ;  while  in  many  instances,  a  portion  of  the  bladder 
in  front,  and  of  the  rectum  behind,  descends  into  the  sac  of  the 
tumor  and  increases  its  bulk.  The  delicate  lining  of  the  vagina, 
dragged  down  and  inverted  by  the  descent  of  the  womb,  furnishes 
an  investment  to  the  whole  mass,  and,  assuming  by  degrees  the 
characters  of  ordinary  integument,  becomes  adapted  to  its  new 
condition.  The  lips  of  the  os  uteri,  however,  and  the  immediately 
adjacent  portion  of  the  cervix  which  the  vagina  does  not  cover, 
retain  in  most  cases  much  of  their  original  delicate  structure,  while 
their  very  position  at  the  most  depending  part  of  the  tumor  exposes 
them  more  than  any  other  part  to  external  injury ;  so  that,  with 


THE  PROCIDENT  UTERUS.  43 

comparatively  few  exceptions,  they  are,  permanently  in  a  state  of 
abrasion  or  superficial  ulceration. 

These  ulcerations  are  generally  indolent,  though  by  no  means  so 
much  so  as  the  ulcers  of  the  inverted  vagina  itself,  which  are  apt 
to  become  deep  and  excavated  with  raised  and  callous  edges,  and 
exactly  to  resemble  chronic  ulcers  of  the  skin  of  other  parts  of  the 
body.  The  abrasions  of  the  os,  however,  after  weeks  or  months 
still  retain  much  the  same  characters  as  they  originally  presented. 
They  extend,  indeed,  at  one  time  over  a  larger  extent  of  surface 
than  they  occupy  at  another;  but  they  very  rarely  increase  in 
depth,  or  extend  into  the  subjacent  tissue.  The  ulcerated  surface 
is  denuded  of  epithelium  ;  now  and  then  it  is  partially  covered  by 
a  thin  layer  of  yellowish  lymph,  but  usually  it  is  of  a  rather  vivid 
red  colour,  and  of  a  granular  appearance.  This  granular  character 
is  generally  more  marked  in  proportion  to  the  age  of  the  ulceration ; 
while  in  a  few  instances  the  granulations  are  distinct  from  each 
other,  rather  elongated  in  form,  and  look  exactly  like  hypertrophied 
papillae.  A  transparent  albuminous  secretion  in  general  covers  the 
ulcerated  surface,  and  is  sometimes  poured  out  freely  from  it ;  but 
there  is  seldom  any  abundant  discharge  from  the  interior  of  the 
uterus,  or  even  from  the  canal  of  the  cervix. 

In  almost  all  cases  of  procidentia  uteri  (those  alone  excepted  in 
which  the  misplacement  of  the  womb  occurs  in  advanced  life,  as  a 
consequence  of  that  general  wasting  of  the  tissues  within  the  pelvis 
which  takes  place  when  the  generative  functions  have  been  long 
extinct),  the  organ  becomes  in  the  course  of  time  more  or  less  con- 
siderably hypertrophied.  This  hypertrophy  usually  affects  the 
neck  of  the  womb  more  than  its  body,  involving  it  in  all  its  dimen- 
sions, though  mostly  to  a  greater  degree  in  length  than  in  thickness. 
It  seems  to  be  a  simple  increase  of  growth,  such  as  we  find  occurs 
in  other  parts  when  subjected  to  constant  and  long-continued  irri- 
tation ;  but  nowhere,  except  perhaps  in  the  female  mamma,  is  it 
observed  so  frequently  or  to  so  great  a  degree  as  in  the  uterus, 
since  nowhere  else  does  there  exist  the  same  store  of  formative 
material,  which  needs  but  a  stimulus  to  excite  it  to  active  develop- 
ment. To  the  touch  the  enlarged  cervix  presents  no  remarkable 
hardness ;  but  its  substance  feels  generally  healthy,  and  the  knife 
of  the  anatomist  detects  no  alteration  in  its  tissue.  There  is  over- 
growth of  the  part,  but  nothing  more. 

That  such  is  the  case,  we  have  additional  proof  in  the  fact  that  a 


44  RESULTS  NOT  VERY  SERIOUS. 

uterus  misplaced,  enlarged,  with  its  orifice  even  abraded,  and 
retained  within  the  pelvis  only  by  some  mechanical  contrivance,  is 
nevertheless  capable  of  performing  all  its  functions,  even  its  highest ; 
and  this  in  many  instances  with  a  remarkably  small  degree  of  dis- 
turbance. Not  only  does  conception  take  place  readily  in  spite  of 
the  existence  of  prolapse  of  the  womb,  but  pregnancy  and  labour 
are  not  seldom  passed  through  with  no  additional  suffering  beyond 
that  which  attended  those  processes  on  former  occasions,  or,  at  the 
worst,  the  increased  discomfort  of  the  patient  is  obviously  due  to 
purely  mechanical  causes. 

It  can  scarcely  be  necessary  to  say,  that  it  is  not  my  intention  for 
one  moment  to  assert  that  misplacement  of  the  womb  produces  no 
inconvenience,  or  that  ulceration  of  its  orifice,  when  it  is  thus  mis- 
placed, is  of  no  importance.  Daily  experience  yields  abundant 
proof  to  the  contrary ;  but  a  detail  of  the  symptoms  of  prolapse  of 
the  uterus  forms  no  part  of  our  present  object.  I  referred  to  the 
accident  and  its  consequences  only  for  the  sake  of  suggesting  the 
reasonable  inference,  that  if  inflammation  of  the  neck  of  the  womb 
were  as  frequent  as  has  been  supposed,  or  ulceration  of  its  orifice 
the  necessary  occasion  of  such  serious  disorder  of  function  apd 
alteration  of  structure,  we  ought  to  meet  with  some  of  the  most 
striking  illustrations  of  these  facts  in  cases  where  the  womb,  by  its 
misplacement,  is  exposed  to  injuries  from  without,  such  as  it  was 
never  intended  to  encounter. 

But  though  it  be  conceded,  as  I  think  it  must  be  by  all  observers, 
that  the  symptoms  supposed  to  characterize  inflammation  of  the 
neck  of  the  womb,  and  ulceration  of  its  orifice,  are  not  met  with 
either  constantly  or  in  a  specially  marked  degree  in  cases  of  pro- 
lapsus or  procidentia  uteri;  still,  we  should  not  be  justified  in  drawing 
an  absolute  conclusion  from  what  we  observe  in  the  misplaced  uterus, 
as  to  the  effects  produced  by  similar  ailments  attacking  the  organ 
when  in  its  natural  position.  It  may  be  alleged,  and  with  plausi- 
bility, that  during  the  gradual  process  of  its  misplacement,  the 
sympathies  of  the  womb  have  been  rendered  less  keen  than  they 
were  while  the  organ  retained  its  natural  position  ;  and  that  thus  it 
comes  to  bear,  with  comparative  impunity,  injuries  which  might 
otherwise  have  produced  great  disorder  of  its  functions  and  great 
alteration  of  its  tissue. 

Bearing  in  mind,  then,  the  necessity  for  care,  lest  from  any  facts 
we  draw  a  wider  inference  than  they  really  warrant,  let  us  now  turn 


ULCERATION  NOT  SEVERE  IN  PROSTITUTES.  45 

to  the  fourth  and  most  important  part  of  this  inquiry,  and  seek  to 
ascertain — 

IV.  What  clinical  observation  generally  teaches  us  concerning 
ulceration  of  the  os  uteri — its  course,  its  symptoms,  and  its  im- 
portance. 

Before  entering  on  the  general  consideration  of  the  subject,  how- 
ever, there  is  one  point  specially  elucidated  by  a  particular  class  of 
patients,  and  concerning  which  it  may  not  be  inappropriate  to  say 
a  few  words.  The  peculiar  susceptibility  of  the  cervix  and  os  uteri, 
the  extreme  readiness  with  which  they  become  the  seat  of  inflamma- 
tion and  ulceration,  are  much  insisted  on  by  those  writers  whose 
opinions  we  are  considering.  Now,  assuming  such  views  to  be 
correct,  we  may,  I  think,  expect  them  to  receive  full  confirmation 
from  the  medical  history  of  those  wretched  women  who  live  by 
prostitution.  In  them,  more  than  in  any  other  class  of  persons,  do 
we  meet  with  the  conditions  best  calculated  to  inflict  local  injury  on 
the  neck  of  the  uterus.  It  will  therefore  be  reasonable  to  expect 
that  they  will  present,  with  remarkable  frequency  and  intensity,  an 
ulcerated  condition  of  the  os  uteri,  an  indurated  and  hypertrophied 
state  of  its  cervix.  It  is  true  that  the  severest  forms  of  these  affec- 
tions must  prevent  persons  labouring  under  them  from  exercising 
their  disgraceful  calling ;  but  yet  no  one  who  is  familiar  with  the 
state  of  wretchedness,  suffering,  and  disease,  in  spite  of  which  the 
lower  order  of  prostitutes  continue  to  ply  their  trade,  but  would 
expect  to  meet  among  them  with  many  instances  of  those  ailments 
in  their  acute  stage,  if  they  were  in  reality  very  frequent.  More- 
over, as  a  hypertrophied  cervix  uteri  returns,  even  under  favourable 
circumstances,  extremely  slowly  to  its  original  size,  there  would  be 
many  occasions  in  which  the  chronic  effects  of  bygone  inflammation 
must  be  evident  in  those  who  had  devoted  themselves  for  months  or 
years  to  a  vicious  life. 

Observation,  however,  seems  to  show  that,  be  the  causes  of  ulcer- 
ation of  the  OS  uteri,  of  inflammation,  hypertrophy,  and  induration 
of  its  cervix,  what  they  may,  sexual  excesses,  at  any  rate,  have  no 
great  share  in  their  production.  Four  years  ago,  being  anxious  to 
satisfy  my  mind  on  this  point,  I  examined,  by  permission  of  Mr. 
Lawrence,  forty  women  on  their  admission  into  the  venereal  wards 
of  St.  Bartholomew's  Hospital.  Of  these  40  patients,  18  suffered 
from  gonorrhoea  alone,  10  from  gonorrhoea  and  syphilis,  and  the 
remaining  12  only  from  syphilis.     The  cases  were  unselected,  and 


46  THREE  DIFFERENT  ANSWERS 

the  examinations  were  made  as  soon  as  possible  after  the  admission 
of  the  patients  into  the  Hospital. 

In  27  instances,  the  os  and  cervix  uteri  were  absolutely  healthy, 
or  presented  only,  and  this  but  rarely,  a  slight  blush  of  redness, 
deepening  the  natural  hue  of  those  parts.  In  10  of  the  remaining 
thirteen,  the  ulceration,  if  indeed  it  deserved  the  name,  was  a  mere 
excoriation  not  above  a  line  in  breadth,  partially  or  completely 
circumscribing  the  os  uteri,  but  associated  with  no  other  change  of 
its  tissue.  In  the  remaining  3  cases,  the  abrasion  was  more  ex- 
tensive, surrounding  the  os  uteri  for  about  a  third  of  an  inch ;  and 
in  the  case  of  one  of  these  three,  that  of  a  woman  who  had  given, 
birth  to  children,  the  lips  of  the  os  were  noted  to  be  elongated: 
this,  however,  was  the  nearest  approach  to  a  hypertrophied  state  of 
the  cervix  met  with  in  the  whole  forty  cases  ;  while  in  no  instance 
was  there  any  such  alteration  of  the  texture  of  the  part  as  to  de- 
serve the  name  of  induration. 

These  facts,  however,  after  all,  prove  no  more  than  this — that 
the  susceptibility  of  the  os  and  cervix  uteri  to  the  effects  of  local 
injury  has  probably  been  over-estimated  ;  they  do  not  bear,  or  bear 
but  very  slightly,  on  the  more  important  inquiry  as  to  the  value  to 
be  attached  to  ulceration  of  the  os  uteri  when  present.  In  ap- 
proaching this  question,  as  we  are  bound  to  do  with  no  conscious 
bias  of  the  mind  in  one  or  the  other  direction,  three  different  pos- 
sibilities at  once  suggest  themselves  to  us,  of  which  any  one  may  be 
correct. 

1st.  Ulceration  of  the  os  uteri  may  be  the  cause  of  all  the  symp- 
toms of  uterine  disease  which  have  been  attributed  to  it ;  and  con- 
sequently it  may  be  of  no  less  importance  to  remove  it  when  present, 
than  to  ascertain  the  fact  of  its  existence. 

2d.  Though  not  in  itself  the  cause  of  the  symptoms,  or  at  least 
of  the  greater  part  of  them,  it  may  yet  be  the  concomitant  of  certain 
forms  of  uterine  disease ;  of  the  state  and  progress  of  which  its 
extent  and  degree  may  be  a  trustworthy  index.  In  this  case, 
though  of  small  importance  as  far  as  therapeutical  proceedings  are 
concerned,  it  may  yet  be  of  great  semeiological  value. 

3d.  Neither  the  one  nor  the  other  of  these  suppositions  may  be 
correct ;  but  either  the  ulceration  may  exist  alone,  giving  rise  in 
that  case  to  few  symptoms,  or  to  none  at  all ;  or  it  may,  in  other 
instances,  complicate  different  uterine  ailments,  though  not  an  index 
of  their  state,  nor  varying  with  their  changes. 


SUGGESTED  TO  THE  INQUIRY.  47 

Considering  that,  in  the  opinion  of  some  writers,  so  large  a  pro- 
portion as  81  per  cent,  of  all  women  presenting  symptoms  of  uterine 
ailment,  are  suffering  from  inflammatory  disease  of  the  tissue  or 
canal  of  the  cervix  uteri,  and  70.4  per  cent,  likewise  from  ulceration 
of  the  OS  uteri,  this  inquiry  can  scarcely  be  expected  to  detain  us 
long.  The  evidence  in  support  of  such  a  view  may  fairly  be  ex- 
pected to  be  overwhelming ;  and  the  symptoms  of  ulceration  of  the 
OS  uteri  to  be  characteristic,  either  from  their  peculiarity  or  their 
severity,  or  from  both  together ;  and  to  differ  in  important  respects 
from  such  as  attend  upon  those  uterine  ailments  which  are  not 
associated  with  that  condition.  Fortunately,  too,  the  presence  or 
absence  of  ulceration  of  the  mouth  of  the  womb  is  a  fact  easily 
ascertainable  ;  so  that  there  can  be  no  difficulty  in  making  this  the 
ground  of  a  division  of  cases  of  uterine  disease  into  two  grand 
classes  for  the  purpose  of  comparison. 

I  purpose,  then,  to  inquire  whether  sterility  is  more  frequent, 
whether  the  rate  of  fecundity  is  lower,  and  whether  abortion  occurs 
oftener  in  the  one  class  of  cases  than  in  the  other  ?  Whether  men- 
strual disorder  is  more  common,  more  severe,  or  different  in  kind ; 
whether  leucorrhoea  is  more  abundant,  or  furnished  from  a  different 
source ;  or  whether  pain  is  less  tolerable  when  the  os  uteri  is  ulcer- 
ated, than  when  that  condition  is  absent  ?  And  lastly,  whether 
similar  or  different  causes  produce  the  uterine  affections  in  the  two 
classes  of  cases;  whether  the  duration  of  illness  is  the  same;  whether 
the  structural  alterations  of  the  womb  are  alike  or  diverse  ? 

If  this  inquiry  should  discover  marked  differences  between  the 
two  classes  of  cases,  it  will  then  be  for  us  to  determine  whether  the 
ulceration  is  to  be  regarded  as  the  cause  of  the  coexisting  disease, 
or  only  as  a  constant  attendant  upon  it  ?  That  it  must  hold  one  or 
other  of  these  places,  will,  I  think,  be  established  beyond  cavil;  and 
it  will  follow  that,  on  either  supposition,  the  importance  of  ascer- 
taining its  existence  can  scarcely  be  overrated. 

If,  on  the  other  hand,  we  find  that  a  very  great  degree  of  resem- 
blance exists  between  the  two  classes  of  cases ;  that  women  of  the 
same  age,  under  similar  circumstances,  present  the  same  symptoms, 
leading  to  the  same  results,  having  the  same  duration,  and  attended 
with  similar  structural  changes,  whether  ulceration  of  the  os  uteri 
be  absent  or  present ;  it  may  then  be  inferred  with  equal  certainty 
that  ulceration  of  the  womb  can  neither  be  regarded  as  a  general 
cause  of  uterine  disease,  nor  as  a  trustworthy  index  of  its  progress ; 


48  DATA  ON  WHICH  TO  FOUND  REPLY. 

but  that  it  is  a  pathological  condition  of  secondary  moment,  and 
this  even  though  there  be  still  some  difficulty  in  assigning  to  it  in 
every  instance  its  proper  value. 

The  materials  from  which  I  hope  to  make  some  approach  to  a 
satisfactory  answer  to  these  questions  are  derived  from  1226  cases, 
of  which  records  were  preserved  while  the  patients  were  under  my 
care,  either  at  the  Middlesex  or  at  St.  Bartholomew's  Hospital.  Of 
these,  300  were  in-patients  of  one  or  other  institution,  and  the  re- 
maining 926  were  out-patients  of  St.  Bartholomew's  Hospital, 
between  Jan.  1,  1850,  and  Oct.  15,  1853.  Conclusions  as  to  the 
results  of  treatment  can  of  course  be  drawn  only  from  the  in- 
patients of  a  hospital ;  but  the  history  of  out-patients  yields,  if 
carefully  recorded,  trustworthy  data  with  reference  to  the  symp- 
toms of  disease.  It  has  been  my  custom  for  the  past  three  years 
to  keep  a  minute  account  of  the  history  of  my  out-patients  at  St. 
Bartholomew's  Hospital — recording  with  reference  to  each  one  her 
age,  the  number  of  years  she  has  been  married ;  if  a  widow,  the 
duration  of  her  widowhood,  the  number  of  children  to  whom  she 
has  given  birth,  as  well  as  that  of  the  abortions  which  she  has  expe- 
rienced, with  the  date  of  her  last  pregnancy.  Further,  the  date  of 
her  first  menstruation,  with  the  manner  in  which  that  function  has 
generally  been  performed,  as  also  the  ordinary  presence  or  absence 
of  leucorrhoeal  discharge,  have  always  been  noted ;  together  with 
the  date  of  the  commencement  of  her  present  illness,  its  symptoms, 
and  the  result  of  vaginal  examination  ;  which  last  I  have  invariably 
made,  and  dictated  the  account  of,  myself.  These  particulars  have 
been  taken  of  all  cases  without  selection — or  if  any  were  omitted, 
they  were  only  some  of  those  cases  of  trivial  ailment  which  all  who 
have  had  much  experience  of  hospitals  know  to  be  never  absent,  in 
certain  proportions,  from  these  institutions ;  cases  sometimes  of 
mere  loitering  idleness,  but  oftener  of  destitution,  where  the  symp- 
toms are  those  of  want,  not  of  disease,  and  food,  not  physic,  is  the 
appropriate  remedy. 

In  268  of  the  1226  cases,  the  symptoms  appeared  to  me  to  justify 
the  use  of  the  speculum ;  and  in  125  instances,  the  os  uteri  was 
found  to  be  the  seat  of  ulceration ;  while  in  the  remaining  143  it 
showed  no  sign  of  that  condition.  Though  for  some  purposes  con- 
clusions may  be  drawn  from  the  whole  number  of  patients,  yet  ob- 
viously the  solution  of  the  questions  before  us  must  be  attempted 


INFLUENCE  OF  ULCERATION  ON  FECUNDITY.      49 

by  a  comparison  of  the  smaller  number  of  instances  in  -which  exa- 
mination with  the  speculum  was  instituted. 

Thus  much  premised  as  to  the  grounds  on  which  the  different  con- 
clusions rest,  to  which  I  now  have  to  crave  your  attention,  we  are 
in  a  position  to  take  up  successively  the  various  points  that  I  have 
already  referred  to  as  likely  to  elucidate  the  question  of  the  influ- 
ence of  ulceration  of  the  os  uteri  in  the  production  of  uterine  dis- 
ease, or  in  occasioning  functional  disorder  of  the  generative  system. 

The  perpetuation  of  the  species  being  the  highest  function  of  the 
generative  apparatus  in  either  sex,  it  is  but  natural  to  expect  that 
any  serious  disease  of  the  organs  which  subserve  that  function  shall 
produce  some  appreciable  effect  in  interfering  with  its  performance, 
and  that  it  shall,  in  the  case  of  women,  show  its  influence  either  in 
the  production  of  absolute  sterility,  in  lessening  the  number  of  con- 
ceptions, or  in  increasing  the  number  of  abortions. 

For  our  purpose  it  is  not  sufiicient  as  a  standard  of  comparison  to 
know  the  proportion  of  children  to  a  marriage  generally  throughout 
this  country  (which  is  about  4.2) ;  but  we  ought  to  ascertain  the 
general  fecundity  of  women  in  the  same  class  of  life,  and  placed 
under  the  same  general  circumstances  with  those  who  apply  as  pa- 
tients at  the  hospital. 

In  the  subjoined  table,  therefore,  the  first  division  represents  the 
proportion  of  pregnancies  which  reached  their  full  term,  and  also 
the  proportion  of  abortions  to  a  marriage  in  980  married  women  at 
different  ages  who  were  attended  in  their  confinement  by  pupils  of 
St.  Bartholomew's  Hospital.  The  second  division  represents  the 
same  fact  in  the  case  of  980  women  married  above  one  year,  who 
applied  during  the  childbearing  period  of  life  for  relief  on  account 
of  any  ailment  of  the  uterine  system,  and  shows  also  the  proportion 
of  cases  in  which  marriage  had  proved  absolutely  sterile.  The  third 
division  represents  the  same  facts  with  reference  to  125  of  the  above 
980  persons  in  whom,  examination  with  the  speculum  having  been 
made,  the  os  uteri  was  found  unaffected  by  ulceration ;  and  its  results 
may  be  compared  with  those  in  the  fourth  division,  which  refers  to 
117  of  the  same  number  of  patients  in  whom  ulceration  of  the  os 
uteri  existed. 


50 


INFLUENCE  OF  ULCERATION  ON  FECUNDITY. 


PATIENTS  WITH  UTERINE 

SYMPTOMS,  WITH 

ULCERATION. 

To  each 

fruitful 

marriage. 

•suoT^jxoqv 

.84 
1.1 
1.75 

^ 

•«»-iPMO    1 

rH         Cq         -^          CO 

CO 

Proportion 

of  sterile 

marriages. 

lin    1.5 
1  in    6.3 
1  in  10.7 

CO 

.a 

•jaqranj^j 

CO         CO         CO         00 

CO             Tj< 

t^ 

PATIENTS  WITH  UTERINE 

SYMPTOMS  WITHOUT 

ULCERATION. 

To  each 

fruitful 

marriage. 

•suoi'^aoqy 

.6 
1.29 
2.47 

CO 

•uaxpnqo 

lO                    CO 

:      <N              CO 

rH*          ^          -^ 

CO 

co' 

Proportion 

of  sterile 

marriages. 

1  in  4.4 
lin  4 

id 

.a 

•jaqranjij; 

:      o      (N      CO 

■^         CO         <M 

§ 

no   H  . 

SI 

To  each 

fruitful 

marriage. 

-•suoi:^joqv 

rH 

^ 

•uajpiiijO 

00 
rH         (M         Tt<         CO 

t^ 

d 

Proportion 

of  sterile 

marriages. 

1  in    3.3 
lin    7.7 
lin    6.8 
lin  17 

00 

.a 

•jaqranj^i 

O      CO      o      t>- 

rH         -"^         lO         1:^ 
CO        CO        (M 

O 
OO 

CD 

1^ 

s 

Abortions 

to  each 

marriage. 

q     "*     ^     "3         «>: 

Children 

to  each 

marriage. 

rH         CO         t-;         CO 
rH        (?q        vd        l-^ 

•jaquin^ 

<M         (M         00         -^ 
lO         CO 

en 

Under  20  years 

Between  20  and  30  years  .     .     . 

"       30    "40      "      ... 

"       40    "50     "     ... 

Totals  and  ayerages      .... 

FECUNDITY  NOT  LESSENED  BY  ULCERATION.      51 

With  reference  to  the  results  of  this  table,  there  can  be  no  doubt 
but  that  the  proportion  of  sterile  marriages  is  really  less,  especially 
in  the  case  of  women  between  twenty  and  thirty  years  old,  than  is 
here  represented.  It  is  true  that  no  cases  are  included  in  it  in  which 
the  women  had  been  married  for  only  a  year,  or  for  a  shorter  time ; 
but  instances  are  by  no  means  uncommon  of  conception  not  taking 
place  till  after  a  lapse  of  two  years  or  more  from  marriage,  although 
there  be  no  obvious  cause  in  the  health  of  either  husband  or  wife  to 
account  for  this  delay.^  But  leaving  the  sterile  marriages  out  of 
the  question,  we  cannot  but  be  struck  with  the  great  diminution  in 
fecundity  in  those  women  who  were  suffering  from  ailments  of  the 
generative  system.  This  result,  however,  instead  of  being  more 
marked  in  cases  of  ulceration  of  the  os  uteri,  than  in  those  where 
no  such  condition  existed,  appears  in  reality  to  be  less  so  ;  while  a 
comparison  of  the  third  and  fourth  divisions  of  the  table  with  the 
second,  indicates  that  other  causes  (such,  I  believe,  as  ovarian  dis- 
eases and  uterine  tumors)  exert  a  more  unfavorable  influence  on 
female  fecundity  than  the  various  morbid  conditions  of  the  cervix  or 
OS  uteri. 

Though  the  table  seems  to  show  that  the  number  of  successful 
pregnancies  was  slightly  greater ;  and  the  number  of  abortions 
slightly  less,  in  those  cases  in  which  ulceration  of  the  os  uteri  was 
present,  than  in  those  in  which  it  was  absent,  I  do  not  wish  to  draw 
from  it  such  a  conclusion.  The  difference  between  the  two  classes 
of  cases  is  but  small,  and  the  number  of  facts  from  which  this  table 
is  constructed  are  too  few  to  justify  any  such  inference;  but  I  do 
think  that  we  are  warranted  in  concluding  that  ulceration  of  the  os 
uteri  does  not  interfere  with  the  performance  of  the  most  important 
function  of  the  generative  system  in  any  peculiar  manner,  or  to  a  i 
greater  degree  than  many  other  uterine  ailments. 

So  many  other  causes,  however,  besides  the  state  of  a  woman's 
sexual  health,  may  interfere  with  conception,  that  we  must  be  ex- 
tremely guarded  in  drawing  conclusions  with  reference  to  it  from 
the  rate  of  her  fecundity  alone.  The  manner  in  which  her  menstrual  ' 
function  is  performed  affords  a  better  index  to  the  healthy  or  diseased 
state  of  her  generative  system;  and  to  that  we  shall  presently  direct 
our  attention.  But  the  more  numerous  the  points  of  view  from  which 
we  compare  cases  of  ulceration  of  the  os  uteri  with  other  cases  of 
uterine  disease,  unattended  by  ulceration,  the  greater  will  be  the 

*  See  M.  Villenne's  observations  on  this  subject  in  Annales  d'Hygi^ne,  torn.  v.  p.  86. 


52 


CONNECTION   OF   ULCERATION  WITH 


probability  of  our  coming  ultimately  to  a  correct  conclusion  with 
reference  to  the  value  of  that  condition.  Before  inquiring  into  the 
state  of  menstruation  in  the  two  classes  of  cases,  we  will  therefore 
compare  them  in  one  or  two  other  respects. 

The  facts  to  which  I  called  your  notice  this  afternoon  with  reference 
to  the  comparative  immunity  of  prostitutes  from  serious  ulceration  of 
the  OS  uteri,  showed  that  mere  excessive  sexual  intercourse  does  not 
exert  a  special  influence  in  the  production  of  that  affection  :  the  table 
we  have  just  examined  has  proved  that  a  woman's  fecundity  is  not 
peculiarly  diminished  by  its  existence.  This  second  table,  however, 
seems  to  render  it  probable  that  some  connection  exists  between  the 
period  of  the  most  vigorous  performance  of  the  sexual  functions  and 
that  state  of  the  uterus  in  which  ulceration  of  its  orifice  is  most  apt 
to  occur;  since,  while  43  per  cent,  of  the  cases  where  ulceration  was 
absent  occurred  after  the  age  of  35,  only  13.6  per  cent,  of  those  in 
which  ulceration  existed  were  met  with  subsequent  to  that  age. 


TABLE  II. 

Showing  the  Age  of  the  Patients  in  the  two  Classes  of  Cases. 


ULCERATION. 

AGE. 

Absent. 

Present. 

Under  20  years 

:..■ 

4 

Between  20  and  30  years 

47 

69 

"       30    "    35     "          ... 

36 

35 

''       35    "   40     *' 

31 

9 

"       40    *<   50     " 

23 

8 

**       60    "   60     " 

3 

Above  60  years 

2 

... 

142 

125 

Of  Ist  class        ....     9 

single                3  not  one  year  married 

Of2d     "           .         .        .        .6 

2 

The  same  fact  may,  perhaps,  be  thought  to  receive  some  slight 
confirmation  from  the  circumstance  that  if  we  inquire  into  the  cause 
of  the  patient's  symptoms  in  the  two  classes  of  cases,  we  shall  find 
that  they  were  attributed  to  marriage,  pregnancy,  or  delivery,  in  48 
per  cent,  of  those  in  which  the  os  uteri  was  ulcerated,  and  only  in 
41  per  cent,  of  those  in  which  nictation  was  absent — a  difference 
however,  which  is  less  marked  if  t^^  cases  only  are  included  in 
which  a  definite  cause  was  assigned  for  the  symptoms. 


ACTIVITY  OP  SEXUAL  FUNCTION^. 


53 


But  be  this  as  it  may,  there  is  at  least  one  point  which  the  sub- 
joined table  clearly  illustrates,  namely,  the  general  identity  of  the 
causes  which  produce  the  symptoms  of  uterine  disease,  whether 
ulceration  of  the  os  uteri  is  present  or  absent. 


TABLE  III. 

Showing  alleged  Causes  of  Uterine  Ailment. 


ULCERATION. 

CAUSES. 

ABSENT. 

PRESENT. 

Actual 

Proportion 

Actual 

Proportion 

numbers. 

per  cent. 

numbers. 

per  cent. 

None  assigned 

55 

38.4 

41 

32.8 

Of  the  remaining        .... 

88 

61.6 

84 

67.2 

Marriage 

10 

11.3 

7 

8.3 

Pregnancy 

3 

3.4 

2 

2.3 

Abortion 

17 

19.2 

16 

19 

Delivery 

27 

30.7 

•    32 

38 

Lactation 

2 

2.2 

3 

3.5 

Gonorrhoea  or  syphilis     . 

13 

14.7 

11 

13 

Disordered  menstruation 

3 

3.4 

Uterine  or  abdominal  inflammation 

1 

1.1 

*3 

3.5 

Injury,  operations  on,  or  diseases  of 

Uterus 

7 

7.9 

4 

4.7 

Sedentary  occupation      . 

2 

2.2 

3 

3.5 

Other  causes           .... 

3 

3.4 

3 

3.5 

88 

99.5 

84 

99.3 

Nor,  indeed,  as  far  as  can  be  judged  from  the  duration  of  the 
symptoms  before  their  severity  or  their  continuance  impelled  the 
patients  to  seek  relief  at  the  hospital,  do  we  find  materials  for  draw- 
ing any  distinction  between  the  two  classes  of  cases.  It  appears 
that,  while  46  per  cent,  of  those  cases  in  which  ulceration  was  absent 
applied  at  the  hospital  within  a  year  after  the  commencement  of 
their  ailments,  not  more  than  47  per  cent,  of  those  in  which  ulcera- 
tion existed  sought  relief  during  the  same  period.  From  this  fact 
it  is,  I  think,  fair  to  infer  that  the  patients  suffered  about  equally 
under  both  circumstances,  and  that  the  symptoms  were  not  mate- 
rially aggravated  by  the  presence  of  ulceration  of  the  os  uteri. 


54 


SIMILARITY   OP   SYMPTOMS 


TABLE  IV. 

Showing  Duration  of  Symptoms  at  Commencement  of  Treatment. 


ULCERATION. 

DURATION. 

ABSENT. 

PRESENT. 

Actual 

Proportion 

Actual 

Proportion 

numbers. 

per  cent. 

numbers. 

per  cent. 

Under  1  month 

7 

6.1 

7 

5.9 

Between  1  and    3  months  . 

14 

10.2 

15 

12.7 

u       3    "     6       " 

27 

19.1 

13 

11 

«       6    "     9       " 

10 

7.3 

7 

5.9 

"       9    <«    12       " 

6 

4.4 

14 

11.8 

♦*     12    «   18       " 

8 

5.8 

6 

5 

<'     18  months  and  2  years 

11 

8 

9 

7.6 

"       2  and    3  years 

12 

8.8 

16 

13.5 

"       3    "     5      " 

16 

11.7 

19 

16.1 

*'       5    '*    10      **  .      . 

15 

11 

10 

8.4 

From  10  years  and  upwards 

10 

7.3 

2. 

1.6 

136 

98.7 

118 

99.5 

If  we  pursue  this  inquiry  further,  and  endeavor  to  ascertain,  as  I 
proposed  doing  a  few  minutes  ago,  whether  the  manifestations  of 
menstrual  disorder  are  alike  or  diverse  in  the  two  classes  of  cases, 
we  shall  but  obtain  another  proof  of  the  same  general  correspond- 
ence between  them. 

TABLE  y. 


Slwwing  the  State  of  Menstruation. 

MENSTRUATION. 

ULCERATION. 

ABSENT. 

PRESENT. 

Actual 

Proportion 

Actual 

Proportion 

numbers. 

per  cent. 

numbers. 

per  cent. 

Natural 

52 

37.6 

36 

30 

Ceased  from  age         .... 

8 

5.7 

— 

In  the  remainder        .... 

78 

56.9 

84 

70 

Modified  as  follows:— 

Suppressed  from  suckling  or  preg- 

• 

nancy          

6 

7.6 

13 

15.4 

Suppressed 

2 

2.5 

1 

1.1 

Irregular         

5 

6.4 

5 

5.9 

Scanty,  or  postponing     . 

10 

12.8 

12 

10.7 

Painful 

17 

21.7 

9 

10.7 

Profuse,  or  anticipating  . 

30 

38.4 

37 

44 

Always  unnatural  in  some  respect  . 

8 

10.2 

7 

8.3 

78 

99,6 

84 

99.6 

Gross  total 

138 

120 

WITH  AND  WITHOUT  ULCERATION. 


55 


This  table,  like  the  others,  comments  on  itself,  and  needs  but  little 
to  be  said  in  the  way  of  explanation;  for  such  differences  as  are 
observed  between  the  two  classes  of  cases  show  no  more  than  a 
somewhat  greater  activity  of  the  sexual  function  in  those  where 
ulceration  was  present  than  in  the  others.  In  them,  pregnancy  or 
Jactation  was  more  frequent ;  scanty,  irregular,  suppressed,  or  painful 
menstruation  was  rarer ;  while  excessive  or  over-frequent  menstrua- 
tion occurred  with  greater  frequency. 


TABLE  VI. 

Showing  the  Relation  of  Leucorrhoea  to  Ulceration  of  the  Os  Uteri. 


LBUCOBBH(EA. 

ULCERATION. 

ABSENT. 

PRESENT. 

Actual 
numbers. 

Proportion 
per  cent. 

Actual 
numbers. 

Proportion 
per  cent. 

Absent 

Present      

13 
125 

138 

10.4 
89.6 

5 
115 

120 

4 
96 

100 

100 

Its  quantity  estimated  in    . 

101 

80.8 

68 

59.1 

Of  these— Profuse 

Scanty    .... 
Moderate 

38 
21 
42 

37.6 
20.7 
41.5 

30 
10 

28 

44.1 
14.7 
41.1 

101 

99.8 

68 

99.9 

Its  sources  determined  in  . 

80 

64 

85 

73.8 

Of  these— from  Uterus    .      ,  . 

Vagina  .         . 

Both 
Also  to  an  appreciable  degree  from 
ulceration  in        ...         . 
From  ulceration  alone     . 

54 

19 

7 

67.5 

23.7 

8.7 

53 
6 
8 

12 
6 

62.3 

7 
9 

14.1 

7 

80 

99.9 

85 

99.8 

But  there  are  other  respects  in  which,  though  at  the  risk  of  seem- 
ing tedious,  a  comparson  may  be  instituted  between  the  two  classes 
of  cases,  with  the  view  of  determining  whether  the  presence  of  ulcer- 
ation of  the  mouth  of  the  womb  alters  the  character  of  the  symptoms, 
or  increases  or  otherwise  modifies  their  severity.  Leucorrhoeal  dis- 
charges are  enumerated  as  among  the  most  constant  and  most  charac- 
teristic symptoms  of  ulceration  of  the  os  uteri.    The  discharge  is  sup- 


56 


SIMILARITY  OF   SYMPTOMS 


posed  to  be  furnished  either  from  the  ulcerated  surface  itself,  or  from 
the  inflamed  and  irritated  canal  of  the  cervix ;  and  the  healing  of  the 
ulceration  is  conceived  to  be  the  first  step  towards  the  cure  of  the 
discharge — often,  indeed,  all  that  is  necessary  for  its  removal.  Let 
us,  therefore,  see  whether  leucorrhoea  is  greatly  more  frequent,  more 
profuse,  or  furnished  from  a  difi'erent  source,  where  ulceration  exists, 
than  in  cases  where  it  is  absent  (see  Table  VI.). 

Now  Table  YI.  appears  to  me  to  show  very  clearly  that  leucorrhoeal 
discharges  are  not  dependent  for  their  cause  upon  any  peculiar  con- 
dition of  the  uterus,  such  as  of  necessity  gives  rise  to  ulceration  of  the 
OS  uteri,  or  such  as  is  itself  consequent  upon  ulceration  of  the  os ;  and 
still  more,  that  they  are  not  furnished  to  any  considerable  degree  by 
the  ulcerated  surface  itself.  It  will  be  seen  that,  in  67  out  of  85 
cases  in  which  the  source  of  the  discharge  was  determined  by  the 
speculum,  or  in  78.8  per  cent.,  no  appreciable  amount  of  secretion 
was  furnished  from  the  abraded  surface  ;  while  the  instances  in  which 
the  abrasion  seemed  to  be  the  sole  source  of  the  discharge  did  not 
exceed  6  out  of  85  cases,  or  7  per  cent,  of  the  total  number. 

If  the  same  kind  of  inquiry  be  extended  to  another  symptom 
seldom  absent  in  uterine  affections — namely,  pain — we  shall  once 
more  find  a  close  correspondence  between  the  two  classes  of  cases. 


TABLE  YII. 

Showing  the  Frequency  and  the  Seat  of  Pain  in  the  two  Classes  of  Cases. 


PAIN. 

ULCERATION. 

ABSENT. 

PBESENT. 

Actual 
numbers. 

Proportion 
per  cent. 

Actual 
numbers. 

Proportion 
per  cent. 

No  complaint  of  pain 

Pain  referred  to  uterus 
"              back 

"             pubic  or  iliac  region  . 
"             uterus  and  back 
*'             uterus  and  pubic  or 

iliac  region     . 
"              back  and  iliac  region 
"             all  these  regions 

21 
36 
31 
7 
24 

12 

9 

21 

143 

14.6 
25.1 

9 

4.8 
16.7 

8.3 

6.2 

14.6 

99.3 

18 

28 

6 

3 

20 

9 
11 
30 

125 

14.4 

22.4 

4.8 

2.4 

16 

7.2 
8.8 
24 

100 

The  only  difiference,  indeed,  seems  to  be  a  slight  one  in  degree, 
such  as  has  been  already  exemplified  in  other  instances. 


WITH  AND  WITHOUT  ULCERATION. 


6T 


Menstruation  was  found  to  be  oftener  excessive,  leucorrhoea  to  be 
more  frequently  profuse,  in  cases  where  the  os  uteri  was  ulcerated  ; 
and,  in  like  manner,  the  existence  of  that  condition  seems  to  be 
accompanied  by  pain  diffused  generally  over  the  whole  pelvic  region 
more  frequently  when  the  os  uteri  is  ulcerated  than  when  ulceration 
is  absent. 

Lastly,  it  remains  for  us  to  inquire  what  was  the  condition  of  the 
uterus,  in  as  far  as  it  could  be  ascertained  by  examination,  in  the 
two  classes  of  cases,  selecting  for  comparison  those  points  which 
admit  of  being  ascertained  most  readily  (see  Table  VIII.). 

TABLE  YIII.* 

Showing  the  State  of  the  Uterus,  in  as  far  as  it  could  he  ascertained,  in 
the  two  Classes  of  Cases. 


STATE  OP  UTERUS. 

ULCERATION. 

ABSENT. 

PRESENT. 

Actual 
numbers. 

Proportion 
per  cent. 

Actual 
numbers. 

Proportion" 
per  cent. 

Uterus  apparently  healthy 

29 

20.8 

36 

30 

Not  healthy  in  some  respect  or  other 

Misplaced  in 

Lower  than  natural 
Eetroverted  or  retroflected 
Anteverted  or  anteflected 

110 

36 

28 

3 

5 

79.2 

32.7 

25.4 

2.7 

4.6 

84 

31 

21 

5 

5 

70 

36.9 

25 
7.9 
7.9 

Its  body  enlarged       .... 

Body  alone 

Os  or  cervix  also  enlarged  or  indurated 

30 
20 
10 

27.2 

18.1 

9 

36 
12 
24 

42.8 
14.2 

28.5 

Its  cervix  or  os  enlarged  or  indurated, 

or  both 

Cervix  or  os  alone  .... 
Body  also 

44 
34 
10 

40 
30.9 
9 

47 
23 
24 

55.9 
27.3 

28.5 

Its  orifice  more  or  less  congested 
With  otherwise  healthy  uterus 
With  enlarged  uterus      . 
With  misplaced  uterus    . 
With  enlarged  or  indurated  os  or  cervix 

58 
20 
9 
12 
17 

52.7 
18.1 
8.1 
10.9 
15.4 

This  last  table  once  more  exemplifies  the  same  general  correspond- 
ence as  we  have  already  noticed  between  the  two  classes  of  cases ; 


'  It  is  almost  needless  to  observe  that  this  table  represents  only  those  morbid  con- 
ditions of  the  uterus  which  bear  upon  the  subject  of  these  Lectures,  and  even  they 
existed  in  several  other  combinations  besides  those  which  are  here  represented. 


t» 


INFLUENCE  OF  ULCERATION  OF  OS 


but  it  also  shows  that  enlargement  of  the  body  of  the  uterus,  and 
enlargement  or  induration  of  its  cervix,  existed  much  more  frequently 
in  connection  with  ulceration  of  the  os  uteri  than  independently  of 
that  condition.  Still,  the  exceptional  cases  are  far  too  numerous  to 
allow  of  the  assumption  that  the  latter  state  is  usually  the  cause  of 
the  former.  Moreover,  in  two-thirds  of  the  cases  where  ulceration 
was  absent,  and  in  one-third  of  those  in  which  it  was  present,  the 
enlargement  was  confined  to  the  body  of  the  womb — a  fact  easily 
reconcilable  with  the  belief  that  that  part  of  the  organ,  as  it  is  of 
the  greatest  physiological  importance,  so  is  also  the  more  frequent 
seat  of  the  gravest  pathological  processes,  or,  at  any  rate,  their 
most  usual  point  of  departure. 

It  also  seems  questionable,  from  the  data  which  this  table  furnishes, 
whether  induration  of  the  os  or  cervix  uteri  is  so  generally  dependent 
on  ulceration  of  the  os  uteri  as  has  been  asserted,  since  it  was  present 
in  40  per  cent,  of  the  cases  where  no  ulceration  existed.  Besides, 
if  such  a  connection  as  that  of  cause  and  effect  subsisted  between 
ulceration  of  the  os  uteri  and  induration  of  its  cervix,  or  even  if  there 
were  any  necessary  relation  of  degree  between  them,  we  ought  to 
find  the  most  extensive  ulceration  coexist  with  the  greatest  hypertro- 
phy and  most  considerable  induration  ;  while  slight  ulceration  of  the 
OS,  and  an  otherwise  healthy  state  of  the  cervix,  might  be  expected 
to  be  usually  found  together.  Facts,  however,  as  will  be  presently 
seen,  do  not  bear  out  this  opinion. 

The  tables  to  which  I  now  beg  your  attention  show  the  data  on 
which  this  assertion  is  rested. 


TABLE  IX. 

Showing  the  Different  Seats  and  Comparative  Frequency  of  Different  Forms 
of  Ulceration  of  Os  Uteri. 


ULCERATION. 

SIMPLE  ABRASION. 

GRANULAR. 

BOTH  VARIETIES. 

Actual 
numbers. 

Proportion 
per  cent. 

Actual 
numbers. 

Proportion 
per  cent. 

Actual 
numbers. 

Proportion 
per  cent. 

Of  anterior  lip 
Of  posterior  lip 
Of  both  lips 

6 
11 

57 

73 

4.1 
9 
47.1 

60.2 

"i 
44 

48 

3.'3 
36.3 

39.6 

5 

15 

101 

121 

4.1 
12.3 
83.4 

99.8 

ON  STATE   OF  UTERUS. 


(59 


TABLE  X. 

Showing  the  Degree  in  which  the  Different  Forms  of  Ulceration  existed. 


ULCERATION. 

SIMPLE  ABRASION. 

GRANULAR. 

BOTH  VARIETIES. 

Actual 
numbers. 

Proportion 
per  cent. 

Actual 
numbers. 

Proportion 
per  cent. 

Actual 
numbers. 

Proportion 
per  cent. 

Slight  .... 
Moderate       .     . 
Extensive      .     . 

31 

33 

9 

73 

25.6 

27.2 

7.4 

60.2 

15 

26 

7 

48 

12.4 

21.2 

6.7 

39.3 

46 
59 
16 

121 

38 

48.4 

13.1 

99.5 

In  121  out  of  the  total  125  cases  of  ulceration  of  the  os  uteri,  its 
seat,  character,  and  extent  were  described  with  minuteness  sufficient 
to  warrant  conclusions  being  drawn  from  them.  I  have  endeavored 
to  discriminate  between  that  form  of  abrasion  which  is  smooth,  con- 
sisting in  a  mere  absence  of  the  epithelium,  or  slightly  aphthous, 
presenting  somewhat  of  a  worm-eaten  appearance — the  epithelium 
being  removed  only  from  small  circumscribed  spots  or  points — and 
the  other  distinctly  granular  variety  of  the  affection.  I  have  also 
considered  as  slight  those  abrasions  which  neither  extended  along  the 
canal  of  the  cervix  nor  reached  for  more  than  a  line  around  the  os 
uteri;  as  moderate,  those  which,  whether  on  one  lip  or  on  both, 
occupied  a  surface  of  two  or  three  lines  in  extent ;  and  as  consider- 
able, all  those  of  greater  dimensions. 

A  further  examination  of  the  cases  represented  in  the  two  pre- 
ceding tables  elicited  two  important  facts. 

1st.  That  in  25  out  of  the  46  cases  in  which  the  ulceration  is 
stated  to  have  been  slight,  more  or  less  considerable  induration  or 
enlargement  of  the  lips  or  neck  of  the  womb  was  present. 

2dly.  That  in  9  out  of  16  cases  in  which  the  ulceration  was 
stated  to  have  been  considerable,  there  was  no  induration  nor  en- 
largement either  of  the  cervix  or  os  uteri. 

The  following  table  represents  the  further  particulars  of  the  above- 
mentioned  16  cases. 


60 


INFLUENCE  NOT   CONSIDERABLE. 

TABLE  XI. 


Showing  the  Various  Conditions  of  the  Uterus  associated  with  Extensive 
Ulceration  of  its  Orifice. 


Uterus  otherwise  healthy 
Body  of  uterus  large 
Uterus  lower  than  natural 
Uterus  large,  cervix  hard 
Uterus  healthy,  but  cervix  hard 
Uterus  healthy,  but  lips  of  os  hard 


Simple 
abrasion. 


Granular. 


Both 
varieties. 


It  seems,  then,  that  while,  on  the  one  hand,  very  slight  ulceration 
of  the  OS  uteri  may  coexist  with  induration  of  the  cervix  of  the 
organ,  very  extensive  ulceration  of  the  os  may,  on  the  other  hand, 
be  compatible  with  an  apparently  healthy  condition  of  the  cervix ; 
and  that,  consequently,  ulceration  of  the  mouth  of  the  womb  and 
induration  of  its  cervix  stand  in  no  constant  nor  necessary  relation 
to  each  other. 

It  would  be  possible,  and  perhaps  not  without  some  profit,  to 
compare  together  the  two  classes  of  cases  which  we  have  been 
studying  from  some  other  points  of  view.  But  we  have  examined 
all  their  more  important  features,  and  each  separate  examination 
has  seemed  to  me  to  lead  to  the  same  conclusion.  More  numerous 
cases  would  doubtless  have  cleared  up  some  obscure  questions — 
would  have  imparted  a  greater  exactness  to  some  of  our  deductions  ; 
but  I  venture  to  think  they  would  not  have  materially  altered  the 
results  which  the  facts  laid  before  you  in  this  Lecture  appear  to 
warrant. 

These  results  may  be  best  summed  up  under  the  five  following 
heads  ;  and  the  order  in  which  they  are  enumerated  nearly  corre- 
sponds with  that  in  which  the  facts  whence  they  are  deduced  were 
successively  brought  under  your  notice. 

1st.  Uterine  pain,  menstrual  disorder,  and  leucorrhoeal  dis- 
charges— the  symptoms  ordinarily  attributed  to  ulceration  of  the 
08  uteri — are  met  with  independently  of  that  condition  almost  as 
often  as  in  connection  with  it. 

2d.  These  symptoms  are  observed  in  both  classes  of  cases  with  a 
vastly  preponderating  frequency  at  the  time  of  the  greatest  vigor 
of  the  sexual  functions,  and  no  cause  has  so  great  a  share  in  their 


CONCLUSIONS  ON  ULCERATION.  61 

production  as  the  different  incidents  connected  with  the  active  exer- 
cise of  the  reproductive  powers.  But  it  does  not  appear  that 
ulceration  of  the  os  uteri  exerts  any  special  influence,  either  in 
causing  sterility  or  in  inducing  abortion. 

3d.  While  the  symptoms  are  identical  in  character  in  the  two 
classes  of  cases,  they  seem  to  present  a  slightly  increased  degree  of 
intensity  in  those  instances  in  which  ulceration  of  the  os  uteri 
existed. 

4th.  In  as  far  as  could  be  ascertained  by  careful  examination, 
four-fifths  of  the  cases  of  either  class  presented  appreciable  changes 
in  the  condition  of  the  uterus — such  as  misplacement,  enlargement, 
and  hardening  of  its  tissue,  while  frequently  several  of  these  condi- 
tions coexisted.  An  indurated  or  hypertrophied  state  of  the  cervix 
uteri  was,  however,  more  frequent  in  connection  with  ulceration  of 
the  OS  uteri  than  independently  of  that  condition. 

5th.  The  inference,  however,  to  which  the  last-mentioned  fact 
would  seem  to  lead,  as  to  the  existence  of  some  necessary  relation, 
such  as  that  of  cause  and  effect — between  ulceration  of  the  os  uteri 
and  induration  of  its  cervix,  is  in  great  measure  negatived  by  two 
circumstances : — 

1.  The  number  of  instances  in  which  an  indurated  cervix  coex- 
isted with  a  healthy  os  uteri. 

2.  The  fact  that,  while  induration  of  the  cervix  was  present  in 
25  out  of  46  cases  in  which  the  ulceration  of  the  os  was  very  slight, 
it  was  altogether  absent  in  9  out  of  16  cases  in  which  the  ulceration 
was  noted  as  having  been  very  extensive. 

These  inferences  sufficiently  show  that  I  do  not  subscribe  to 
either  the  first  or  second  of  those  three  conclusions,  one  or  other  of 
which,  it  was  stated  at  an  early  period  of  this  Lecture,  would 
probably  be  found  to  represent  the  truth  of  this  matter ;  that  I  do 
not  regard  ulceration  of  the  os  uteri  either  as  the  general  cause 
of  the  symptoms  which  have  been  attributed  to  it,  or  even  as 
a  general  concomitant  of  them,  and  index  of  their  degree  and  seve- 
rity. It  would,  indeed,  have  simplified  the  study  and  the  treatment 
of  uterine  disease  very  much,  to  have  found  that  a  slight  erosion  of 
the  mucous  membrane  of  the  least  important  part  of  the  womb  was 
the  cause  of  four-fifths  of  those  painful  ailments  to  which  the  female 
sex  is  liable ;  but  I  will  venture  to  add  that  it  would  have  shown 
diseases  of  the  womb  to  constitute  a  most  marvellous  exception  to 
the  ordinary  rules  of  pathology. 


62  CONCLUSIONS  ON  ULCERATION. 

If,  then,  there  be  no  more  here  thai^  elsewhere,  any  royal  road  to 
knowledge,  it  remains  for  us  only  to  make  out,  as  best  we  may, 
with  what  varied  states  of  the  general  health,  or  of  the  sexual 
system,  the  various  signs  of  uterine  disease  are  connected  ;  to  learn 
how,  in  different  cases,  we  may  surely  distinguish,  or  even  shrewdly 
guess,  their  import.  The  task  is  tedious,  perhaps,  but  it  is  the 
same  as  in  all  other  departments  of  medical  inquiry  we  have  to  en- 
counter. 


LECTUEE   III. 

Causes  of  uterine  ailments  very  various — sometimes  independent  of  local  disease,  as 
in  the  case  of  chlorosis,  of  hepatic  disorder,  of  granular  disease  of  the  kidneys, 
of  the  gouty  or  rheumatic  patient — all  illustrate  the  dependence  of  uterine 
disorder  on  constitutional  disease.  Ulceration  of  the  os  uteri,  when  present  in 
such  cases,  of  secondary  importance;  and  equally  so  in  many  instances  where 
disease  really  begins  in  the  uterus  itself,  as  in  ailments  succeeding  to  pregnancy, 
abortion,  delivery,  etc. 

Sketch  of  the  history  of  a  patient  in  whom  menorrhagia  succeeds  to  delivery  or  to 
abortion;  case  in  illustration  of  defective  involution  of  the  uterus,  and  its 
results.  Inquiry  as  to  the  result  of  inflammation  attacking  the  uterus  under 
these  circumstances;  case  in  illustration — reasons  for  believing  the  mischief  in 
such  cases  to  begin  in  the  interior  of  the  womb,  confirmed  by  history  of  patient 
in  whom  uterine  inflammation  succeeded  to  gonorrhoea ;  extension  of  this  hypo- 
thesis to  explanation  of  other  somewhat  similar  cases.  Importance  of  a£"ections 
of  canal  of  cervix  uteri  believed  to  have  been  overrated,  and  why. 

Ulceration  of  os  uteri  not  absolutely  unimportant ;  case  illustrative  of  symptoms  of 
its  simplest  form — characters  which  it  presents — uncertainty  as  to  nature  of 
some  of  them — remarks  on  so-called  Granular  Metritis.  Question  of  local  treat- 
ment in  some  instances  in  which  ulceration  persists  after  subsidence  of  original 
ailment. 

Explanation  suggested  of  alleged  cures  of  uterine  ailment  by  local  use  of  caustics — 
mischievous  result,  both  to  patient  and  practitioner,  of  the  opinions  on  which 
their  indiscriminate  employment  is  founded.  Cases  considered  in  which  the 
stronger  caustics  are  alleged  to  be  required;  practice  objected  to,  and  why. 
Reference  to  exceptional  cases  of  ulceration  calling  for  local  treatment;  pecu- 
liarity in  case  of  uterus  modifies  nature  and  mode  of  employment  of  local 
remedies. — Concluding  observations. 

Mr.  President — 

Sir:  The  task  of  to-day  is  a  far  more  difficult  one  than  was  that 
of  either  of  the  two  previous  days  ;  and  in  my  endeavor  to  fulfil  it, 
I  shall  stand  more  than  ever  in  need  of  your  kind  indulgence. 
Hitherto,  I  have  been  engaged  in  the  attempt  to  show  what  I  believe 
to  be  the  fallacies  of  certain  opinions  which  come  before  us  not  only 
recommended  by  high  authority,  but  also  attractive  from  their  sim- 
plicity, from  the  easy  explanation  that  they  profess  to  offer  of  very 
varied  and  very  complex  processes  of  disease,  and  from  the  uniformity 
of  the  treatment  that  they  suggest  as  applicable  alike  to  all. 


64  CONSTITUTIONAL   CAUSES. 

It  may  not  unnaturally  be  expected  that,  before  undertaking  so 
invidious  an  oflSce,  I  was  prepared  with  some  other  solution  of  these 
different  morbid  phenomena  equal  to  that  which  I  reject  in  its  sim- 
plicity and  in  the  universality  of  its  application,  but  claiming  to 
rest  OQ  stronger  grounds,  and  to  be  open  to  fewer  objections. 

Unfortunately,  I  can  put  forward  no  such  pretensions,  for  I  believe 
that  instead  of  the  different  symptoms  which  are  supposed  to  depend 
on  ulceration  of  the  os  uteri  being  produced  by  that  or  by  any  other 
single  cause,  they  in  reality  arise  from  very  various  causes ;  that  at 
one  time  they  attend  on  general  constitutional  disorder,  at  another 
on  some  ailment  of  the  sexual  system,  and  that  ailment  by  no  means 
the  same  in  every  instance.  If  this  be  so,  however,  instead  of  the 
consideration  of  one  pathological  condition  of  the  uterus  and  its 
possible  consequences,  we  have  to  inquire  into  little  less  than  uterine 
disorders  in  general,  their  causes  and  their  symptoms — an  under- 
taking which  would  occupy  not  one  Lecture,  but  several ;  and  the 
preparation  for  which  would  be  the  study  of  a  lifetime. 

All,  then,  which  I  can  attempt  will  be  to  furnish  a  few  illustrations 
of  the  subject,  such  as  may  serve,  if  to  do  no  more,  at  least  to  show 
the  direction  that  investigation  should  take  in  order  to  remove  the 
difficulties  by  which  it  is  surrounded. 

A  not  infrequent  instance  of  disorder  of  the  uterine  function, 
independent  of  ailment  of  the  organ  itself,  is  afforded  us  in  the  case 
of  the  chlorotic  girl,  in  whom  the  menses  scarcely  show  themselves 
for  months  together,  while  an  abundant  white  discharge  is  often 
poured  forth  from  the  uterus,  either  constantly  or  with  an  ill-marked 
periodicity,  and  uterine  and  lumbar  pains  attend  upon  the  symptoms. 
Remedies  improve  the  general  health,  correct  the  morbid  state  of  the 
circulating  fluid,  and  step  by  step  the  local  ailments  improve  too  ; 
the  leucorrhoea  subsides,  the  pain  ceases,  and  all  indications  of 
uterine  disorder  disappear,  although  the  womb  itself  has  never  been 
the  object  of  special  treatment. 

Or,  in  another  and  usually  a  much  older  person,  the  liver  performs 
its  functions  but  imperfectly;  constipation,  headache,  an  icteroid 
tinge  of  the  skin,  mark  its  disorder :  at  length  menstruation  comes 
on  with  unusual  profuseness,  and  the  signs  of  hepatic  disturbance 
disappear.  This  may, occur  but  once,  or  it  may  occur  several  times  ; 
the  slightest  error  in  diet,  the  slightest  neglect  of  the  state  of  the 
bowels,  or  some  cause  too  trivial  to  be  discovered,  may  produce 
the  same  derangement  of  the  function  of  the  liver,  which  may 


CAUSES   OF   UTERINE   AILMENTS.  Q5 

again  give  rise  to  the  same  train  of  symptoms,  and  cease  on  the 
recurrence  of  a  similar  hemorrhage.  But  nature's  healing  power 
is  often  ill-regulated;  and,  erring  in  too  little  or  too  much,  the  regu- 
lar periodicity  of  the  menstrual  function  becomes  deranged ;  many 
weeks  pass  without  the  appearance  of  the  menses,  and  then  they 
appear  again  and  again  with  a  frequency  and  profuseness  which 
seriously  impair  the  patient's  health,  which  sometimes  even  threaten 
her  life. 

Or,  again,  the  kidneys,  from  unsuspected  disease,  perform  their 
duties  incompletely,  and  the  blood,  imperfectly  depurated,  its  red 
particles  diminished,  its  watery  elements  increased,  pours  forth  at 
the  return  of  each  periodical  congestion  of  the  womb  in  larger 
quantities  than  when  the  patient  was  in  health.  Leucorrhoeal  dis- 
charges follow  in  the  intervals  of  menstruation  ;  pain  is  felt  in  the 
back  ;  bearing-down  follows  any  exertion ;  the  frequent  micturition 
seems  to  indicate  the  sympathetic  suffering  of  the  bladder,  while  the 
loss  of  muscular  tone,  and  the  long  persistence  of  congestion  of  the 
womb  at  every  period,  favor  the  actual  prolapsus  of  the  organ.  The 
patient  seems  to  be  sinking  under  monorrhagia  ;  she  is  really  dying 
from  the  effects  of  granular  degeneration  of  the  kidneys,  and  conse- 
quent albuminuria. 

Or,  lastly,  to  take  another  illustration  of  the  mode  in  which  uterine 
symptoms  depend  on  constitutional  causes,*  let  us  notice  how  im- 
portant a  part  the  gouty  and  rheumatic  diathesis  sometimes  plays 
in  the  production  of  uterine  symptoms.  A  casual  attack  of  cold  is  in 
some  instances  referred  to  as  the  occasion  of  the  patient's  illness,  while 
in  other  cases  the  ailment  comes  on  by  degrees,  and  with  no  definite 
exciting  cause.  Menstruation  begins  to  be  more  painful  than  was 
its  wont,  often  more  scanty  ;  an  unusual  degree  of  constitutional 
disturbance  attends  each  period  ;  the  pulse  at  those  times  is  very 
frequent,  the  skin  hot  though  perspiring,  and  lithates  abound  in  the 
urine.  In  the  intervals,  profuse  leucorrhoeal  discharges  take  place  ; 
the  pain,  though  less  intense,  is  yet  severe,  and  is  aggravated  by 
trifling  causes,  or  without  any  obvious  reason.  The  pain  at  one 
time  is  most  severe  in  the  back,  at  another  is  referred  to  one  or 
other  iliac  region,  shooting  down  the  legs,  in  the  course  of  the 

^  The  observations  of  Dr.  Todd  on  this  subject,  in  Section  ix.  of  Practical  Remarks 
on  Gout,  Rheumatism,  Fever,  &c.  8vo.  London,  1843,  and  those  of  Dr.  Rigby,  in  his 
work  on  Dysmenorrhoea,  published  in  1844,  have  more  specially  called  attention  to 
this  subject. 

5 


66  CONSTITUTIONAL   CAUSES 

crural  nerve,  or,  like  sciatica,  aifecting  the  back  of  the  thighs  ;  while 
occasionally,  in  addition  to  these  abiding  discomforts,  the  patient  is 
kept  in  bed  for  a  day  or  two  at  a  time  by  slight  feverish  attacks, 
accompanied  by  wandering  pains  in  the  limbs,  though  seldom  at- 
tended by  inflammation  and  swelling  of  any  of  the  joints. 

Cases  of  this  kind  are  met  with  in  all  classes  of  society  ;  and 
wherever  they  occur  they  are  chronic  in  their  course  and  difficult 
of  cure.  Among  the  poor  they  do  badly  out  of  a  hospital ;  for  rest, 
uniformity  of  temperature,  and  a  suitable  diet  can  seldom  be  ob- 
tained ;  while  they  do  but  ill  in  a  hospital,  since  the  absence  of 
regular  occupation  and  of  exercise  cannot  but  be  injurious,  while 
the  listlessness  of  mind  which  the  patient's  state  and  circumstances 
engender  is  favourable  to  hypochondriasis,  and  to  the  exaggeration  of 
any  ailment  of  the  nervous  system.  The  aff"ection  is  one  not  unusual 
among  young  women  who  follow  the  occupation  of  book-folding, 
working,  as  they  are  compelled  to  do,  in  a  heated,  but  at  the  same 
time  in  a  damp  atmosphere,  and  for  the  most  part  in  ill-ventilated 
apartments.  A  very  obstinate  case  of  it  came  under  my  notice 
some  time  since  in  a  young  person  who  had  been  compelled,  by 
lameness  from  birth,  to  lead  a  very  sedentary  life,  and  who  had 
always  suff'ered  from  vague  rheumatic  pains.  And  not  long  since, 
a  washerwoman,  whose  finger-joints  were  enlarged  by  chalk-stones, 
but  in  whom  menstruation  had  already  ceased,  applied  at  the  Out- 
Patient  room  of  St.  Bartholomew's  Hospital  on  account  of  profuse 
leucorrhoea  and  rheumatic  pains,  which  disappeared  simultaneously 
under  the  use  of  colchicum  and  iodide  of  potassium. 

The  rich  enjoy  no  immunity  from  this  ailment.  A  lady,  who  had 
suff'ered  severely  from  rheumatism  in  India  some  twenty  years  before, 
experienced  more  or  less  of  these  symptoms  ever  since ;  and  when 
I  saw  her,  menstruation  having  ceased  for  more  than  a  year,  leu- 
corrhoea still  persisted,  associated  with  abundant  deposits  of  lithates 
in  the  urine,  a  tendency  to  eczema  of  the  vulva,  and  most  intense 
tenderness  of  the  uterus,  though  that  organ  had  already  begun  to 
undergo  the  atrophy  of  age.  An  unmarried  lady,  aged  35,  who 
inherited  gout  from  her  father,  displayed  the  symptoms  just  men- 
tioned, with  the  exception  of  the  cutaneous  affection,  most  severely ; 
and,  in  addition,  suff'ered  much  from  pain  in  the  back  and  dysuria, 
excreting  from  time  to  time  very  large  quantities  of  lithic  acid 
crystals.  Errors  in  diet,  and  all  the  accidents  inseparable  from 
mixing  in  society,  render  this  ailment  almost  as  unmanageable  among 


OF   UTERINE   AILMENTS.  67 

•the  wealthy  as  it  is  among  the  poor,  and  the  chances  of  relapse 
nearly  as  great.  In  either  class  of  patients  improvement  in  the 
general  health  is  associated  with  amendment,  though  not  with  an 
equivalent  amendment,  in  the  uterine  symptoms ;  while  any  exa- 
cerbation of  suffering  is  accompanied  by  most  abundant  deposits  of 
lithates  in  the  urine,  and  by  a  specific  gravity  of  that  fluid  as  high 
as  1030°  or  1035°. 

That  the  muscular  tissue  of  the  uterus  should,  under  these  circum- 
stances, be  the  seat  of  extreme  pain  is  just  what  might  be  expected. 
The  distinction,  indeed,  between  rheumatic  and  neuralgic  pain  is  not 
very  clear ;  and  many  cases  resembling  those  of  irritable  uterus,  as 
described  by  the  late  Dr.Gooch,  with  all  that  graphic  skill  of  which 
he  was  so  great  a  master,  may  be  referred  to  this  category.  The 
treatment  which  affords  relief  is  just  such  as  the  state  of  the  urine 
and  the  assumed  rheumatic  character  of  the  symptoms  would  seem 
to  indicate.  Colchicum,  iodide  of  potassium,  diaphoretics  and  seda- 
tives, alkalies  and  vegetable  bitters,  are  the  remedies  on  which  we 
must  rely  to  obtain  amendment,  and  by  which,  under  favourable  cir- 
cumstances, we  may  even  accomplish  a  cure. 

Now  it  scarcely  need  be  observed  that,  in  the  different  classes  of 
cases  glanced  at,  disease  of  the  womb  is  not  the  cause  of  the  symp- 
toms, nor  can  it  be  by  medication  of  that  organ  that  we  can  hope  to 
cure  the  patient.  I  have  known  a  lady  in  whom  amenorrhoea  and 
nienorrhagia  alternated,  associated  with  obstinate  functional  disorder 
of  the  liver,  flood  to  death  from  a  uterus  which  was  small  and,  as 
far  as  careful  examination  during  life  could  ascertain,  quite  healthy. 
Pain  and  exquisite  tenderness  of  the  uterus  existed  in  another  case 
just  referred  to,  together  with  abundant  leucorrhoeal  discharge, 
although  the  menstrual  function  had  not  only  ceased,  but  the  uterus 
had  begun  to  undergo  the  atrophy  of  age.  True  it  is,  that  a  uterus 
from  which  hemorrhage  takes  place  more  frequently  and  more  abun- 
dantly than  natural,  may  be  found  larger  and  heavier  than  it  will 
be  weeks  afterwards,  when  treatment  has  stanched  the  bleeding  or 
reduced  its  occurrence  to  the  proper  times,  and  confined  its  quantity 
within  the  natural  limits.  It  is  also  true  that  a  limited  abrasion  of 
the  OS  uteri  is  now  and  then  present  in  some  of  these  cases,  but  it 
is  neither  considerable  in  extent  nor  uniform  in  its  presence ;  it 
exists  one  day,  and  is  not  to  be  discovered  a  week  afterwards ;  and 
then  again  it  reappears,  once  more  to  vanish.  But  what  of  that  ? 
The  dyspeptic  patient  has  a  congested  palate,  or  enlarged  tonsils,  or 


68  OCCURRENCE   OF   UTERINE 

even  aphthous  ulcerations  of  the  mucous  membrane  of  the  mouth ; 
and,  as  the  extremity  of  the  digestive  tube  sympathizes  with  the 
disorders  of  its  important  parts,  so  does  the  orifice  of  the  womb 
often  afford  an  index  to  the  condition  of  its  interior.  With  the 
restored  health,  the  swollen  tonsils  or  the  soreness  of  the  mouth 
disappear ;  and  so,  when  the  uterine  congestion  subsides,  its  orifice 
resumes  a  natural  aspect.  The  abrasion  of  the  os  in  these  cases  is 
indeed  very  slight,  much  slighter  than  we  shall  find  it  to  be  in  other 
instances  in  which  the  cause  of  the  symptoms  is  seated  in  the  sexual 
organs  themselves ;  but,  if  I  do  not  mistake,  the  explanation  just 
suggested  of  the  import  of  ulceration  will  be  found  to  be  often  appli- 
cable even  to  them. 

The  tables  to  which  reference  was  made  in  the  last  Lecture 
showed  that,  in  a  very  large  proportion  of  cases — between  40  and 
50  per  cent. — marriage,  pregnancy,  abortion,  or  delivery,  was  re- 
ferred to  as  the  exciting  cause  of  the  symptoms  from  which  the 
patients  suffered  ;  while  these  symptoms  were  just  of  that  kind  which 
are  often  attributed  to  ulceration  of  the  os  uteri. 

According  to  the  opinion  of  some  observers,  these  causes  act  by 
producing  inflammation  of  the  cervix  uteri,  and  consequent  ulceration 
of  its  orifice,  of  which  occurrences  all  the  different  phenomena  we 
have  noticed  are  the  direct  or  indirect  results.  Others,  however 
— and  I  confess  myself  to  be  of  that  number — demur  to  this  ex- 
planation, and  believe  that  these  cases  not  only  allow,  but  require, 
a  different  interpretation.  We  will  select  for  examination  one  of 
the  most  frequent,  and  at  the  same  time  of  the  simplest  kind.  A 
woman,  after  delivery,  leaves  her  bed  too  soon,  or  makes  some  inju- 
dicious exertion  at  a  time  when  the  uterus  is  still  heavy,  its  vessels 
are  still  large,  and  the  process  of  involution  of  its  tissue  is  still 
incomplete,  while  the  persistence  of  some  lochial  discharge  shows 
that  exfoliation  of  the  mucous  membrane  of  its  cavity,  which  is  re- 
peated again  and  again  after  parturition,  has  not  come  to  an  end. 
Perhaps  no  striking  ill  effect  is  produced  at  the  time,  but  blood  still 
continues  to  flow  through  vessels  which,  under  other  circumstances, 
would  long  since  have  ceased  to  convey  it,  and  whose  collapsed  walls, 
undergoing  the  same  fatty  degeneration  as  the  rest  of  the  old  uterine 
tissue,  would  have  been  in  course  of  removal.  The  lochial  discharge, 
indeed,  persists,  but  the  patient  experiences  no  other  inconvenience 
until  the  lapse  of  about  a  month  after  her  delivery.  Then,  however, 
the  ovaries,  in  obedience  to  the  law  of  their  periodic  activity,  make 


AILMENTS   AFTER   DELIVERY.  69 

a  slight  effort  to  resume  their  wonted  function— an  effort  which,  in 
the  healthy  subject,  is  just  indicated,  and  no  more.  But,  under  the 
less  favourable  circumstances  in  which  this  woman  has  placed  herself, 
the  undue  congestion  of  her  sexual  organs  that  before  existed  be- 
comes now  raised  to  a  point  at  which  hemorrhage  breaks  out  from 
the  interior  of  her  womb.  This  hemorrhage  lasts  for  some  days 
and  then  subsides,  but  abundant  secretion  from  the  mucous  mem- 
brane still  continues  ;  and  before  long — probably  under  the  influence 
of  a  return  of  ovarian  excitement — a  fresh  outbreak  of  hemorrhage 
occurs,  and  then  another,  until,  by  the  frequent  return  of  bleeding, 
and  by  the  profuse  secretion  from  the  mucous  membrane  in  the 
intervals,  the  blood  becomes  impoverished  and  the  health  enfeebled. 
If  we  examine  such  a  patient,  we  shall  probably  find  her  uterus 
lower  down  than  natural,  its  size  and  weight  increased,  its  orifice 
open,  its  cervix  short,  and  its  tissue  soft,  while  the  epithelium  of  the 
OS  may  or  may  not  be  somewhat  abraded.  Whence,  now,  in  this 
case  comes  the  hemorrhage  ?  whence  the  abundant  leucorrhcea  ? 
what  importance  is  to  be  attached  to  the  abrasion  of  the  os  uteri 
when  it  is  present  ?  The  discharges  are  doubtless  furnished  in  great 
measure  from  the  uterine  cavity,  within  which  all  the  important 
physiological  processes  of  pregnancy,  labour,  and  its  consequences 
have  been  recently  transacted  ;  in  part,  perhaps,  from  the  whole 
tract  of  the  Fallopian  tubes,  which  may  be  found,  at  an  ordinary 
menstrual  period,  distended  to  double  or  treble  their  usual  caliber 
by  a  thick  mucus  stained  by  admixture  of  blood  to  a  rose  colour,  or 
even  to  a  deeper  tint.  The  lining  membrane  of  the  cervix  uteri 
doubtless  participates  in  the  general  congestion  ;  its  mucous  crypts 
probably  pour  out  their  secretion  with  more  than  usual  abundance, 
and  thus  add  to  the  leucorrhcea ;  but  no  one  can  suppose  that,  in 
such  a  case  as  this,  the  source  of  the  symptoms  is  to  be  found  in 
the  neck  of  the  womb,  or  that  the  absence  of  epithelium  for  a  few 
lines  around  its  orifice  is  here  a  matter  of  the  slightest  pathological 
importance. 

The  same  occurrence  may  follow  after  abortion,  and  happens, 
indeed,  more  frequently  then  than  after  delivery  at  the  full  period, 
since  the  necessity  for  care  is  less  apparent.  The  symptoms  which 
attend  it  are  the  same,  and  under  their  persistence  the  involution  of 
the  uterus  may  for  weeks  be  completely  arrested. 

A  married  woman,  the  mother  of  five  children,  and  who  had 
miscarried  three  times,  but  not  successively,  was  received  into  St. 


70  DEFICIENT   INVOLUTION   OF  THE   UTERUS. 

Bartholomew's  Hospital  on  account  of  symptoms  which  she  had  ex- 
perienced since  a  miscarriage  at  the  third  month  six  weeks  pre- 
viously. She  suffered  from  a  constant  discharge,  almost  always 
tinged  with  blood,  and  sometimes  from  profuse  hemorrhage.  She 
complained  of  great  pain  at  the  lower  part  of  her  back  and  of  her 
abdomen,  and  of  a  constant  bearing-down  sensation,  which  was  much 
aggravated  on  any  attempt  at  exertion,  or  effort  at  defecation ; 
her  countenance  was  pale,  and  expressive  of  pain,  and  her  pulse  was 
feeble.  On  examination,  the  uterus  was  found  low  down,  retroverted, 
its  orifice  looking  directly  forwards,  and  about  two  inches  from  the 
vulva  ;  its  body  and  fundus  enlarged,  so  as  to  form  a  globular  tumour, 
about  the  size  of  a  small  apple,  the  walls  of  which  were  elastic. 
The  anterior  lip  of  the  uterus  was  thin  and  small,  the  posterior 
somewhat  thicker,  and  about  half  an  inch  longer.  The  os  uteri 
was  open,  and  the  finger  could  be  passed  for  a  short  distance  without 
occasioning  pain.  The  uterine  sound  was  introduced  with  the  con- 
cavity directed  backwards  :  on  turning  it  round,  the  tumour  before 
mentioned  completely  disappeared,  the  sound  passing  to  the  extent 
of  5|  inches,  showing  the  uterus  to  be  three  inches  larger  than 
natural.  > 

Rest,  tonics,  and  the  cold  douche  to  the  uterus,  arrested  the  he- 
morrhage, greatly  checked  the  discharge,  and  improved  the  patient's 
health.  The  uterus,  however,  remained  of  about  the  same  dimen- 
sions at  the  end  of  a  fortnight,  when  the  outbreak  of  smallpox  in 
the  ward  necessitated  the  woman's  discharge  from  the  hospital.  I 
saw  her  again  once  six  weeks  afterwards,  and  the  uterus  was  greatly 
diminished  in  size ;  but  I  had  not  then  the  opportunity  of  ascertaining 
its  exact  dimensions  by  means  of  the  uterine  sound.  Other  cases  of 
a  similar  kind  have  at  different  times  come  under  my  notice,  but  I 
do  not  remember  any  in  which  the  uterus  remained  of  so  large  a 
size  as  in  the  instance  just  related. 

In  the  above-mentioned  instance,  and  in  many  others  of  a  similar 
kind,  there  is  no  evidence  of  any  other  morbid  condition  than  a  mere 
deficient  involution  of  the  uterus.^ 

It  must,  however,  be  at  once  apparent  that-  such  a  state  is  one  in 
which  processes  akin  to  inflammation  will  be  very  likely  to  supervene, 

*  See,  with  reference  to  this  subject,  a  short  but  very  interesting  paper,  by  Pro- 
fessor Simpson,  on  Morbid  Deficiency  and  Morbid  Excess,  in  the  Involution  of  the 
Uterus  after  Delivery,  in  the  Monthly  Journal  for  1852. 


TENDENCY  OF  UTERUS  TO  HYPERTROPHT.       71* 

and  to  aggravate  the  patient's  condition  ;  while,  even  should  that 
not  be  the  case,  the  law  which  connects  hypertrophy  of  an  organ 
with  long-continued  congestion  of  its  vessels,  will,  at  any  rate,  not 
meet  with  an  exception  in  the  case  of  the  uterus.  No  organ  of  the 
body  presents  naturally  conditions  so  favourable  to  the  occurrence  of 
hypertrophy  as  the  uterus,  since  nowhere  else  is  there  the  same  store 
of  formative  material,  only  awaiting  some  stimulus  to  excite  it  to 
development.  The  presence  of  an  impregnated  ovum  in  its  cavity, 
is  the  appropriate  stimulus  which  awakens  to  the  full  its  dormant 
vital  energies.  But  I  need  not  mention  how  the  development  of 
an  extra-uterine  ovum,  the  formation  of  a  polypus  in  the  cavity  of 
the  womb,  the  growth  of  a  fibrous  tumour  in  its  wall,  even  the  can- 
cerous disease  which  destroys  its  substance,  will  also  call  those 
energies  into  activity,  and  cause  the  uterus  to  grow  to  dimensions 
far  exceeding  those  which  it  naturally  presents.  It  may,  indeed, 
be  stated  that  excitement  of  the  uterus  of  almost  any  kind  during 
the  period  of  sexual  activity  tends  to  increase  its  size  :  and  further, 
that  this  increase  of  size  will  be  marked  in  proportion  as  the  stimulus 
acts  upon  the  cavity  of  the  organ,  and  not  simply  upon  its  cervix. 
How  different  is  the  amount  of  uterine  enlargement  produced  by  a 
small  fibrous  tumour  imbedded  in  its  walls  near  to  its  cavity,  from 
-that  which  accompanies  even  a  large  cancerous  growth  from  its  cer- 
vix !  Enlargement  of  the  neck  of  the  womb  may,  probably  generally 
does,  accompany  enlargement  of  its  body  ;  but  that  the  latter  is  the 
consequence  of  the  former  appears  to  me  to  be,  in  the  majority  of 
instances,  not  merely  not  proved,  but  even  opposed  to  probability. 

But  it  may  be  asked,  what  does  inflammation  do  if  it  attacks  the 
uterus  in  these  cases  ?  If  this  question  be  put  as  to  the  intimate 
nature  of  the  changes  which  it  works  in  the  uterine  tissue,  I  must 
confess  that  I  do  not  know ;  and  may  add  that,  to  the  best  of  my 
knowledge,  no  one  competent  to  attempt  the  investigation  has  ap- 
plied himself  to  the  elucidation  of  this  so  difficult  problem.  If, 
however,  the  inquiry  be  limited  to  those  obvious  results  apparent  to 
the  ordinary  observer,  I  think  I  may  say  that  it  produces  pain  of  a 
severer  kind  than  is  experienced  in  the  other  cases;  pain  present- 
ing somewhat  of  a  paroxysmal  character,  and  sometimes  even  being 
excruciating  from  its  intensity  ;  while  even  in  its  absence  there  is 
extreme  tenderness  of  the  uterus,  with  great  heat  of  the  vagina,  and 
usually  a  very  abundant  purulent  leucorrhoea,  often,  though  by  no 
means  invariably,  tinged  with  blood.     Moreover,  these  local  symp- 


72  RESULTS   OF   INFLAMMATION 

toms  are  associated  with  more  or  less  considerable  constitutional 
disturbance ;  while  on  their  subsidence,  the  uterine  tissue,  as  far  as 
its  state  can  be  ascertained,  is  felt  to  be  harder  in  texture  than 
before  ;  and  lastly,  these  symptoms,  when  once  they  have  occurred, 
are  apt  to  return  at  uncertain  intervals  during  a  period  of  many 
years,  presenting  on  each  occasion  the  same  characters,  amenable  to 
the  same  treatment,  but  in  spite  of  it  retaining  the  same  disposition 
to  recur  over  and  over  again. 

In  September,  1851,  a  married  woman,  aged  41,  was  admitted  into 
St.  Bartholomew's  Hospital,  and  told  the  following  history  of  her 
ailments :  Having  married  at  sixteen,  at  which  time  the  menstrual 
discharge  was  scanty,  and  irregular  in  its  return,  she  at  once  became 
pregnant,  but  miscarried  at  the  third  month.  A  second  pregnancy 
terminated  at  the  full  period  after  a  lingering  labour  of  two  days  and 
a  half  duration,  in  the  eighteenth  year  of  her  age ;  and  a  third 
pregnancy  soon  afterwards  likewise  terminated  prematurely  at  the 
fourth  month.  Her  symptoms  dated  from  the  time  of  her  lingering 
abour;  and  consisted  of  leucorrhoeal  discharge,  sometimes  very 
copious,  occasionally  also  very  offensive  ;  constant  sense  of  dis- 
comfort in  the  uterine  region,  with  occasional  sharp  stabbing  pain, 
chiefly  referred  to  the  right  groin,  and  always  aggravated  at  a  men- 
strual period ;  while  the  menstrual  discharge,  which  for  years  had 
been  gradually  increasing  in  quantity,  and  was  now  extremely  pro- 
fuse, was  always  succeeded  by  temporary  relief  to  the  patient's  suffer- 
ings. The  pain  and  the  hemorrhage  together  had  worn  down  her 
health ;  her  countenance  was  anxious,  and  her  pulse  128,  and  feeble. 
The  uterus  was  found  to  be  rather  low  down,  but  not  much  enlarged, 
though  very  tender;  the  cervix  uteri  was  indurated,  somewhat  elon- 
gated, and  very  painful;  and  the  os  uteri,  which  was  small  and 
circular,  presented  no  trace  of  abrasion,  either  affecting  its  lips 
or  extending  into  the  canal  of  the  cervix,  though  the  congestion 
of  that  part  was  very  marked.  Rest,  frequent  local  leeching,  and 
sedatives,  relieved  the  patient's  sufferings,  improved  diet  restored 
her  strength,  and  when  she  left  the  hospital,  in  November,  she 
had  lost  the  sense  of  pain  and  bearing-down ;  there  was  but  little 
leucorrhoea,  the  tenderness  of  the  uterus  was  much  diminished, 
and  the  congestion  of  its  orifice  had  entirely  disappeared.  It  may 
be  added  that  once,  during  the  course  of  her  treatment,  superficial 
abrasion  of  the  os  uteri  showed  itself,  but  disappeared  of  its  own 
accord  in  a  few  days.    Great  as  the  relief  was  which  this  poor  woman 


OF   ENLARGED   UTERUS.  T8| 

had  obtained,  I  did  not  anticipate  that  she  would  continue  free  from 
suffering  if  she  returned  home  to  bear  a  part  in  the  duties,  and  to 
submit  to  the  hardships,  which  are  inseparable  from  poverty.  Ac- 
cordingly, in  less  than  twelve  months,  she  returned  to  the  Hospital, 
presenting  the  same  symptoms  as  before,  and  submitted  to  a  similar 
plan  of  treatment  with  the  like  result.  The  os  uteri  on  this  occasion 
«lso  presented  no  abrasion,  though  frequent  examinations  were  made 
with  the  speculum  to  ascertain  this  fact.  The  patient  remained  this 
time  somewhat  longer  than  before  in  the  Hospital,  and  took  small 
doses  of  the  bichloride  of  mercury  for  several  weeks,  though  never  in 
such  quantities  as  to  affect  the  mouth.  For  six  months  after  her 
discharge  she  continued  almost  free  from  suffering;  but  in  September, 
1853,  her  symptoms  began  to  return:  menstruation,  though  not  so 
profuse  as  before,  became  once  more  very  painful:  and  for  some  days 
before  her  admission  into  the  Hospital  on  October  20,  she  had  pa- 
roxysms of  such  intense  severity  that  she  rolled  about  the  bed  in 
uncontrollable  agony  ;  which  large  doses  of  sedatives  were  unable  to 
subdue.  On  her  admission,  there  was  the  same  intense  congestion  of 
the  OS  uteri  as  on  former  occasions,  with  a  very  abundant,  highly 
offensive,  purulent  discharge,  slightly  tinged  with  blood  from  its 
interior ;  the  womb  itself  being  low  down,  somewhat  larger  than 
natural,  and  the  cervix  large,  hard,  swollen,  and  intensely  tender  ; 
but  no  trace  of  abrasion  of  the  os  was  perceptible.  The  application 
of  six  leeches  to  the  uterus  was  followed  by  bleeding  so  profuse  as  to 
cause  syncope  ;  but  for  several  days  subsequently  the  patient  con- 
tinued perfectly  free  from  pain,  and  though  it  afterwards  returned, 
yet  it  never  again  attained  the  same  degree  of  intensity.  She 
remained  in  the  Hospital  for  six  weeks  ;  during  which  time  local 
leeching  was  occasionally  resorted  to,  small  doses  of  the  bichloride 
of  mercury  were  again  given,  together  with  the  syrup  of  the  iodide 
of  iron ;  and  under  this  treatment  improvement  once  more  took 
place,  and  the  neck  of  the  womb  at  the  time  of  the  patient's  dis- 
charge was  at  least  a  third  smaller  than  it  had  been  at  her  admis- 
sion. 

In  this  instance,  we  observe  symptoms  of  the  greatest  severity 
recurring  again  and  again  without  ulceration  of  the  os  uteri,  or  of 
the  canal  of  the  cervix  (for  the  slight  abrasion  apparent  once,  and 
then  vanishing  spontaneously  in  the  course  of  a  few  days,  cannot 
be  regarded  as  of  importance) ;  and  this  was  observed  during  three 
distinct  attacks  of  illness,  spread  over  a  period  of  three  years.     I 


74'  '  IMPORTANCE   OF  AFFECTIONS 

apprehend  that  one  does  not  err  in  connecting  the  patient's  illness 
■with  some  inflammatory  affection  of  the  mucous  membrane  of  her 
uterus,  which,  supervened  upon  her  delivery,  and  which,  during  the 
many  subsequent  years,  was  every  now  and  then  lighted  up  afresh 
by  causes  which  in  the  household  of  the  poor  are  not  far  to  seek. 
In  this  instance  it  is  true  that  the  most  marked  enlargement  of  the 
uterus  was  perceptible  in  the  neck,  not  in  the  body  of  the  womb; 
but  I  doubt  whether  a  diff"erence  from  other  cases  in  this  respect  is 
a  matter  of  so  much  importance  as  at  first  it  may  appear.  When  a 
woman  has  frequently  given  birth  to  children  at  the  full  period,  the 
portio  vaginalis  of  the  cervix  uteri,  or  in  other  words  that  portion 
of  the  neck  of  the  womb  which  projects  into  the  vagina,  becomes 
greatly  shortened,  sometimes  almost  completely  disappears,  while  it 
commonly  remains  of  considerable  length  in  the  case  of  women  who 
have  only  aborted,  or  at  most  have  given  birth  only  to  one  or  two 
children  at  the  full  period.  The  deficient  involution  of  the  uterus 
after  a  miscarriage,  will  in  such  cases  be  shared  in  its  measure  by 
the  cervix  uteri,  and  by  as  much  of  the  portio  vaginalis  as  exists  ; 
and  to  this  circumstance,  rather  than  to  any  essential  difference,  I 
am  disposed,  in  a  large  proportion  of  instances,  to  attribute  the 
difference  in  size  of  the  portio  vaginalis.  But  admitting  even  that 
this  explanation  is  not  conclusive,  and  that  the  condition  of  the 
cervix  is  of  more  importance  than  I  have  just  suggested,  the  fact 
still  remains  that  all  the  symptoms  of  ulceration  of  the  os  uteri,  and 
even  that  enlargement  of  the  cervix  which  is  said  to  depend  upon  it, 
were  observed  during  a  period  of  many  months,  and  observed  to  be 
unconnected  with  any  such  state  during  the  whole  of  that  period. 

It  would  not  be  difficult  to  multiply  cases  of  this  description  if 
time  allowed ;  but,  in  further  illustration  of  the  subject,  I  will  just 
refer  to  one  other  of  a  kindred  nature.  In  some  few,  h'appily  very 
few  cases,  the  inflammation,  which  in  gonorrhoea  is  usually  limited 
to  the  vagina,  not  only  attacks  the  mucous  membrane  of  the  bladder, 
but  affects  the  lining  of  the  uterus  also,  and  even  extends  to  the 
peritoneum,  sometimes  endangering  the  patient's  life.  But  without 
causing  those  most  formidable  results,  acute  inflammation  of  the 
vagina  sometimes  extends  beyond  its  original  seat,  and  gives  rise  to 
symptoms  such  as  we  are  now  considering.  A  patient,  aged  thirty- 
five,  was  admitted  into  St.  Bartholomew's  Hospital,  complaining  of 
dysuria  and  frequent  micturition,  of  painful  and  profuse  menstrua- 
tion, and  of  leucorrhoeal  discharge — symptoms  which  she  referred 


OF  UTERINE   CAVITY.  75 

to  a  somewliat  severe  attack  of  gonorrhoea  three  months  before. 
Her  uterus  was  found  much  enlarged,  anteverted,  and  fixed  in  its 
unnatural  position,  while  its  tissue  generally  was  much  harder  than 
natural,  and  the  margins  of  the  os  uteri,  though  free  from  the 
slightest  trace  of  abrasion,  presented  a  very  marked  congestion,  and 
discharge  was  poured  out  from  the  interior  abundantly.  It  is  here, 
I  think,  no  unfair  assumption  to  suppose  that  all  these  symptoms, 
from  which  the  patient  had  never  suffered  previous  to  the  gonorrhoea, 
were  excited  by  it ;  that  that  had  affected  the  interior  of  the  uterus, 
and  had  also  bound  down  the  organ  in  its  unnatural  position  by 
adhesions  consequent  on  peritoneal  inflammation.  At  any  rate, 
here  was  no  ulceration  of  the  orifice  of  the  womb,  and  yet  here 
were  all  the  symptoms  which  are  usually  described  as  indicative  of 
its  presence. 

It  is  w^ell,  also,  to  bear  in  mind,  with  reference  to  cases  of  this 
and  of  a  similar  kind,  that  the  assumption  of  inflammation  affecting 
the  body  of  the  womb  is  not  sufficiently  negatived  by  the  absence  in 
the  patient's  history  of  any  mention  of  symptoms  so  grave  as  we 
might  be  inclined  to  imagine  that  inflammation  of  the  more  import- 
ant parts  of  this  viscus  must  of  necessity  produce.  In  making* 
examinations  after  death,  we  constantly  find  adhesions  between  the 
uterus  and  rectum,  or  matting  together  of  the  parts  within  the  fold 
of  one  or  other  broad  ligament,  although  the  patient  during  her 
lifetime  may  never  have  mentioned  any  attack  of  uterine  or  abdomi- 
nal inflammation.  Not  unfrequently,  too,  we  find  the  uterus  firmly 
fixed  in  the  pelvis,  with  most  obvious  thickening  of  the  broad  liga- 
ment, or  of  the  pelvic  cellular  tissue ;  while  yet  the  closest  inquiry 
will  fail  to  elicit  anything  more  definite  than  the  statement  that  a 
bad  confinement  or  a  bad  miscarriage  some  time  before  was  succeeded 
by  a  painful  and  tedious  convalescence. 

Other  cases  might  be  mentioned  which,  I  believe,  admit  of  the 
same  interpretation — cases  where  the  symptoms  have  succeeded  to 
marriage,  or  where  they  have  followed  suppressed  menstruation  ; 
nor  would  I  propose  a  different  explanation  of  those  instances  in 
which  uterine  misplacements,  as  anteflexion  or  retroflexion,  are 
succeeded  by  signs  of  sexual  disorder  such  as  we  have  been  consid- 
ering, or  where  they  have  been  associated  with  misplacement  of  the 
ovary.  In  all  of  these  instances  it  is,  I  believe,  the  interior  of  the 
uterine  cavity  which  suffers  first — it  is  thence  that  the  hemorrhages 
are  derived,  thence  that  the  greater  part  of  the  leucorrhoeal  discharge 


7d.  IMPORTANCE   OF  AFFECTIONS 

is  furnislied ;  and  it  is  the  irritation  of  that  part  of  the  organ  in 
which  its  most  important  functions  are  transacted,  which  leads  to 
the  increase  of  its  size  so  apparent  in  the  great  proportion  of  cases 
of  long- continued  uterine  ailment.  That  the  ovaries  suifer  too, 
constant  observation  proves ;  and  facts  illustrative  of  the  affection 
of  the  neck  of  the  womb  are  also  perpetually  coming  under  our 
notice  ;  but  that,  as  a  general  rule,  inflammation  of  the  canal  of  the 
cervix  is  the  first  step  in  the  disease,  and  ulceration  of  the  os  uteri 
the  second ;  and  that  these  two  conditions  are  the  two  factors  pro- 
ducing all  the  symptoms  we  have  been  studying,  is  an  assumption 
which  I  cannot  but  regard  as  unsupported  by  facts,  and  as  opposed 
to  any  fair  inference  from  what  anatomy,  physiology,  or  analogical 
reasoning  teach  us. 

There  are,  however,  some  writers  who,  while  they  concede  the 
comparatively  small  importance  of  ulceration  of  the  os  uteri,  yet 
appear  to  me  (and  I  trust  that  these  my  doubts  are  always  expressed 
with  that  respect  and  deference  for  the  opinions  of  others  which  I 
sincerely  entertain)  scarcely  to  attach  due  weight  to  the  ailments  of 
the  uterine  cavity.  The  elaborate  secretory  apparatus  of  the  cervix 
uteri,  so  minutely  described  and  so  beautifully  delineated  by  Dr. 
Hassall  and  Dr.  Tyler  Smith,  seems  indeed  to  furnish  an  ample 
source  for  almost  any  conceivable  amount  of  discharge.  But  it 
must  be  remembered  that,  like  many  other  secreting  apparatuses, 
this  is  by  no  means  in  constant  activity.  Its  full  action  seems  to 
be  called  forth  only  during  pregnancy  ;  and  my  own  observation  does 
not  by  any  means  confirm  the  statement,  that  in  the  intervals  between 
the  menstrual  periods  a  mucous  plug  is  secreted,  hermetically  closing, 
as  it  were,  the  canal  of  the  cervix ;  for  I  have  observed  any  such 
secretion,  to  say  the  least,  quite  as  often  absent  as  present  in  uteri 
which  I  have  examined.  Moreover,  at  each  menstrual  period  it  is 
the  mucous  membrane  of  the  body  of  the  uterus  which  is  congested, 
and  from  which  the  mucus  and  epithelium,  as  far  as  we  can  ascertain, 
are  derived,  which  form  at  its  commencement  and  end  the  greater 
part  of  the  menstrual  flux,  and  constitute  the  white  discharge  that 
not  infrequently  continues  in  the  healthy  subject  for  twelve  or  twenty- 
four  hours  after  the  cessation  of  all  admixture  of  blood.  Nor  must 
it  be  forgotten  that  the  mucous  membrane  of  the  uterine  cavity  is 
furnished  with  appropriate  glands  to  furnish  such  secretion  almost 
infinite  in  number,  curiously  convoluted  to  increase  the  extent  of 
their  surface,  and  susceptible  of  a  peculiar  hypertrophy  more  re- 


OF  CERVICAL  CANAL  EXAGGERATED.  77 

markable  than  any  which  is  observed  to  take  place  in  the  glands  of 
the  cervix.  Observation  also  not  infrequently  discovers  the  mem- 
brane of  the  uterine  cavity  abundantly  moistened  with  secretion  ; 
while  cases  are  now  and  then  met  with  in  which  inflammation  having 
attacked  it,  it  pours  out  abundance  of  pus. 

Such  a  case  sometime  since  came  to  my  knowledge  ;  and  the 
uterus,  removed  from  the  patient  after  death,  is  now  in  the  Museum 
of  St.  Bartholomew's  Hospital.  A  fibrous  tumour  growing  in  the 
substance  of  the  posterior  uterine  wall  occasioned  an  unusual  amount 
of  irritation  of  the  pelvic  viscera,  the  cause  of  which  was  not  detected 
during  the  patient's  life.  After  death,  this  tumour,  of  the  size  of  a 
small  apple,  was  seen  to  be  most  intensely  injected,  while  the  mucous 
membrane  of  the  uterine  cavity,  into  which,  however,  the  tumour 
did  not  at  all  project,  was  of  the  brightest  possible  rose  tint,  and 
looked  like  red  velvet.  Pus  had  been  poured  out  from  the  ftiflamed 
mucous  membrane,  and  collecting  within  the  uterine  cavity  all  the 
more  readily  from  the  neck  of  the  womb  having  become  bent  upon 
itself,  so  as  to  prevent  the  ready  escape  of  fluids  from  the  interior, 
had  distended  it,  as  may  be  seen  in  the  specimen,  to  the  size  of  a 
hen's  egg. 

It  is  true,  indeed,  that  our  means  of  investigation  do  not  enable 
us,  during  the  lifetime  of  our  patients,  to  ascertain  beyond  a  doubt 
whether  a  discharge  poured  out  from  the  os  uteri  is  furnished  from 
the  cervical  canal,  or  from  higher  up  in  the  body  of  the  uterus,  or 
from  both.  Probability  appears  to  me  to  incline  to  its  being  chiefly 
derived  from  the  uterine  cavity ;  though  I  do  not  doubt  but  that  it 
is  often  furnished  in  a  measure  by  the  cervix  also.  The  weight  of 
proof  seems  to  me  to  lie  upon  those  who  see  in  leucorrhoea  only  a 
hypersecretion  from  the  glandular  apparatus  of  the  cervix  uteri. 
Moreover,  it  is  not  only  the  excessive  mucous  or  purulent  discharge 
which  in  these  cases  attracts  our  notice  and  calls  for  our  interference, 
but  menstrual  disorder,  abdominal  and  pelvic  pain,  uterine  enlarge- 
ment— all  that  category  of  symptoms,  in  short,  which  have  been  so 
often  dwelt  on  in  these  Lectures,  that  to  refer  to  them  again,  even 
in  the  briefest  manner,  seems  an  almost  needless  tediousness. 

But  it  may  not  unnaturally  be  asked,  whether  I  then  believe  that 
the  condition  of  so-called  ulceration  of  the  os  uteri  is  one  of  abso- 
lutely no  importance,  adding  nothing  to  a  patient's  suff'erings,  in  no 
respect  protracting  her  illness,  calling  for  no  treatment  ?  I  do  not 
believe  this ;  though  at  the  same  time  disease  of  the  os  uteri  is  so 


"TjS  symptoms  of  ulceration 

almost  invariably  associated  with  other  evident  ailments  of  the  organ 
as  to  render  it  very  difficult  to  distinguish  accurately  one  set  of 
symptoms  from  the  other.  That  the  existence  of  an  abraded  condi- 
tion of  the  OS  uteri  is  capable  of  producing  under  some  circumstances 
very  considerable  discomfort,  is,  however,  certain ;  and  is  proved 
by  cases  such  as  the  following  :  — 

A  woman,  twenty-seven  years  of  age,  who  had  lived  in  sterile 
marriage  with  two  husbands,  was  admitted  into  St.  Bartholomew's 
Hospital  on  account  of  dysmenorrhoea.  The  canal  of  the  cervix 
uteri  was  extremely  narrow ;  and,  under  the  impression  that  the 
case  was  one  of  those  comparatively  rare  instances  of  menstruation 
rendered  difficult  by  mechanical  causes,  sponge  tents  were  introduced 
to  dilate  the  contracted  cervix.  The  presence  of  the  sponge  tent, 
though  causing  no  other  inconvenience,  occasioned  a  very  distressing 
sense  of  itching  referred  to  the  uterus  :  on  the  withdrawal  of  the  tent, 
the  edges  of  the  os  uteri  and  the  cervical  canal,  as  far  as  it  could 
be  seen,  were  observed  to  be  very  red,  and  quite  denuded  of  their 
epithelium,  while  a  rather  abundant  glairy  secretion  was  poured  out 
from  their  surface.  So  long  as  the  abrasion  continued,  and  it  did  not 
disappear  till  three  days  after  the  removal  of  the  sponge  tent,  the 
sense  of  itching  and  the  discharge  continued,  though  with  gradually 
diminishing  severity.  Causes  so  purely  local  in  their  action  are  of 
course  very  rare  ;  but  symptoms  such  as  were  here  produced  by 
mechanical  irritation  are  sometimes  observed  in  other  cases  in  which 
disease,  as  far  as  can  be  ascertained,  is  confined  to  the  os  uteri. 

I  will  but  just  allude  here,  by  way  of  illustration,  to  cases  in 
which  the  earliest  stage  of  uterine  cancer  has  been  attended  with 
some  vague  sense  of  itching,  burning,  or  smarting,  referred  to  the 
mouth  of  the  womb :  to  do  more  than  merely  mention  them  would 
take  us  away  from  our  more  immediate  subjects.  But,  independent 
of  such  cases,  it  happens  now  and  then  that  without  any  other,  or 
at  any  rate  with  very  little  other,  appreciable  evidence  of  uterine 
disease,  one  observes  the  orifice  of  the  womb  present  a  red,  coarsely 
granular  surface,  from  which  a  glairy  secretion  is  poured  forth 
abundantly.  This  surface  is  somewhat  tender  to  the  touch,  and 
bleeds  so  readily  that  even  the  most  careful  examination  with  the 
speculum  causes  the  blood  to  flow.  Much  more  rarely  I  have  also 
"Seen  what  looked  more  like  an  ordinary  ulcer  with  sharply  cut  edges  ; 
its  surface  apparently  a  little  depressed  below  the  adjacent  tissue, 
partially  covered  by  a  thin  layer  of  dirty  yellowish  lymph,  but  red, 


OF   OS   UTERI.  79 

and  bleeding  on  its  removal.  Both  of  these  conditions  I  have 
usually  noticed  in  women  whose  previous  history  contained  mention 
of  some  syphilitic  infection  only  a  few  months  previously ;  though  I 
should  hesitate  to  class  the  appearances  among  secondary  syphilitic 
symptoms.  ,. 

I  apprehend  that  the  marked  granular  appearance  is  due  to  hyper- 
trophy of  those  papillae  covering  the  surface  of  the  os  uteri,  for  our 
acquaintance  with  which  we  are  indebted  to  the  late  Dr.  Franz 
Kilian,  of  Mayence ;  whose  early  death  it  may  be  permitted  me 
here  to  deplore,  since  it  was'  as  much  too  soon  for  science  as  for  his 
own  fair  fame ;  while  unanswered  problems  remind  one  painfully 
every  day  of  the  loss  of  him  who  had  proved  himself  so  well  fitted 
to  attempt  their  solution.  In  these  cases,  the  analogy  between  the 
state  of  the  os  uteri  and  that  granular  condition  of  the  palpebral 
conjunctiva  observed  in  purulent  ophthalmia,  would  seem  to  be  com- 
plete ;  and  no  one  who  has  observed  the  abundant  secretion  poured 
out  from  between  the  lids  of  the  infant  affected  by  that  disease,  need 
wonder  at  the  amount  of  discharge  furnished  from  so  comparatively 
small  a  surface  as  the  os  uteri.  That  sometimes  there  is  an  actual 
destruction  of  substance  over  and  above  the  mere  abrasion  of  epithe- 
lium, can  also  not  be  doubted ;  but  I  believe  that  this  is  not  generally 
the  case.  With  reference  to  the  morbid  states  of  the  os  uteri,  how- 
ever, there  is  much  need  of  careful  microscopic  research.  We  hear 
of  phlebitis  of  its  minute  vessels,  of  herpes  and  eruptive  diseases 
affecting  its  surface :  terms  expressive  sometimes  of  a  theory,  at 
other  times  descriptive  of  the  character  of  an  appearance  which 
presented  itself  to  the  observer;  but  such  phraseology  cannot  at 
present  be  accepted  as  a  statement  of  any  well-ascertained  patholo- 
gical fact. 

One  of  these  conditions  I  must  notice,  because  it  is  met  with 
independent  of  other  uterine  disease,  and  presents  characters  so 
-marked  as  to  have  attracted  the  notice  of  Boivin  and  Dug^s,  and 
to  have  received  from  them  a  distinct  name  as  granular  metritis. 
Under  this  not  very  appropriate  name,  two  different  conditions  at 
least  have  been  described.  In  one,  numerous  small,  rather  hard, 
miliary  prominences  beset  both  lips  of  the  os  uteri,  usually,  but  not 
invariably,  destitute  of  epithelium,  giving  exit  when  pricked  to  a 
small  drop  of  mucus  or  muco-pus,  and  being  probably  hypertrophied 
follicles.  The  other  condition  is  produced  by  a  number  of  small, 
soft,  red  papulae,  similar  in  size  to  those  just  mentioned,  very  vascu- 


80  AFFECTIONS   OF   OS   UTERI  AKIN   TO   ULCERATION. 

lar,  bleeding  easily,  but  solid,  and  probably  identical  in  structure 
with  the  granulations  ascertained  by  M.  Robin  to  be  small  hyper- 
trophied  points  of  mucous  membrane  ;  and  which,  occasionally  deve- 
loped in  the  uterine  cavity,  have  been  the  object  of  a  somewhat 
over-active  treatment  on  the  part  of  M.  R^camier  and  some  other 
practitioners,  who,  believing  them  to  produce  obstinate  leucorrhoea, 
menstrual  irregularity,  and  other  ills,  scrape  out  the  uterine  cavity 
with  a  blunt  instrument,  and  find  in  the  blood-stained  debris  of  the 
mucous  membrane  the  proofs  of  their  diagnostic  skill,  and  the  tro- 
phies of  their  chirurgical  dexterity.  These  states  of  the  os  uteri, 
however,  though  by  no  means  common,  are  unquestionably  attended 
with  leucorrhoeal  discharge,  often  very  profuse,  with  a  tendency  to 
slight  bleeding  from  their  surface  ;  while  they  produce  uncomfort- 
able sensations  of  itching,  smarting,  and  the  like,  not  amounting, 
indeed,  to  actual  pain,  but  quite  sufficient  to  keep  alive  all  the 
patient's  anxiety  lest  they  should  be  the  portent  of  some  worse 
ailment  to  follow. 

Affections  such  as  these  have  seemed  to  call  for  local  treatment, 
and  when  resorted  to,  I  have  seen  them  yield  under  it,  and  the 
patient  return  rapidly  to  health.  These  cases,  however,  are,  I  be- 
lieve, exceptional  ones,  and,  in  the  majority  of  instances,  the  morbid 
state  of  the  os  uteri  is  but  a  part  of  the  general  disease  which  has 
attacked  the  organ ;  the  ulceration  persisting,  now  larger,  now 
smaller,  presenting  different  aspects,  not  as  the  cause  of  the  symp- 
toms, but  with  them  dependent  on,  and  expressive  of,  the  influence 
of  another  and  a  common  cause.  What  causes  these  may  be  I  have 
already  stated.  But  even  in  such  cases,  it  has  seemed  to  me  that 
the  ulceration  has  itself  sometimes  outlasted  the  graver  evils  under 
which  it  arose,  and  has  remained ;  causing  discomfort,  leucorrhoea, 
and  slight  sanguineous  discharge,  and  keeping  up  a  perpetual  dispo- 
sition to  uterine  congestion,  which  but  for  it  would  subside.  That, 
under  such  circumstances,  a  tendency  to  slow  increase  in  the  size 
of  the  cervix  uteri  should  exist,  is  surely  no  matter  for  wonder, 
since  the  neck  of  the  womb  is  more  exposed  to  irritation  of  every 
kind  than  any  other  part  of  the  organ ;  while,  slight  though  the 
morbid  state  may  be,  it  yet  is  sufficient  to  produce  some  increased 
afflux  of  blood  thither,  whence  its  return  is  more  difficult  than  from 
any  other  part ;  and  we  have  already  seen  how  great  is  the  tendency 
in  the  uterine  tissue  under  any  stimulus,  either  natural  or  morbid,  to 


LOCAL   TREATMENT   OF   ULCERATION.  81 

some  degree  of  that  hypertrophy  which,  during  thirty  years  of  life, 
represents  its  highest  physiological  condition. 

It  cannot  be  necessary  that  I  should  say  a  word  to  point  out  the 
difference  between  these  opinions  and  those  which  I  have  ventured 
to  criticize,  and  according  to  which  inflammation  of  the  cervix  and 
ulceration  of  the  os  uteri  are  the  first  and  the  last  in  uterine  patho- 
logy. It  may,  however,  be  asked,  how  is  it  that  such  successful 
results  have  followed  a  course  of  treatment  directed  exclusively  to 
the  cure  of  the  ulceration — that^  the  application  of  caustics  to  the 
OS  uteri  has  been  succeeded  by  the  restoration  of  the  patient  to 
health  ?  Now,  I  think  it  should  be  borne  in  mind  that,  in  connection 
with  this  mode  of  treatment,  various  other  measures  are  of  necessity 
adopted,  eminently  calculated  to  relieve  many  of  the  slighter  forms 
of  uterine  ailment.  The  married  woman  is  for  a  time  taken  from 
her  husband's  bed;  the  severe  exertion  to  which  either  a  sense  of 
duty  urged,  or  a  love  of  pleasure  prompted  her,  is  discontinued  ; 
while  rest  in  the  recumbent  posture  places  the  uterus  and  the  pelvic 
viscera  in  just  that  position  in  which  the  return  of  blood  from  them  j 
encounters  the  smallest  difficulties.  The  condition  of  the  bowels, 
probably  before  habitually  neglected,  is  now  carefully  regulated, 
and  the  patient's  diet,  bland,  nutritious,  and  unstimulating,  often 
differs  widely  from  that  with  which,  while  all  her  functions  were 
overtaxed,  she  vainly  strove  to  tempt  her  failing  appetite.  Add  to 
this,  that  the  occurrence  of  the  menstrual  period  is  carefully  watched 
for ;  that  all  precautions  are  then  redoubled,  and  each  symptom  of 
disorder,  such  as  on  former  occasions  had  been  borne  uncomplain- 
ingly, though  often  not  without  much  suffering,  is  at  once  encoun- 
tered by  its  appropriate  remedy ;  while  generally  returning  conva- 
lescence is  met  in  the  higher  classes  of  society  by  a  quiet  visit  to 
the  country,  or  to  some  watering-place,  in  pursuit  not  of  gayety,  but 
of  health;  and  we  have  assembled  just  those  conditions  best  fitted^ 
to  remove  three  out  of  four  of  the  disorders  to  which  the  sexual  J 
system  of  woman  is  subject.  But  the  very  simplicity  of  these  mea- 
sures is  a  bar  to  their  adoption  ;  for  you  will  bear  me  out  in  saying, 
that  the  rules  which  common  sense  cannot  but  approve,  but  which 
seem  to  require  nothing  more  than  common  sense  to  suggest  them, 
are  just  those  to  which  our  patients  least  readily  submit.  The  case 
is  altered,  however,  when  these  same  rules  are  laid  down  not  as  the 
means  of  cure  themselves,  but  only  as  conditions  indispensable  to 
the  success  of  that  cauterization  which,  repeated  once  or  oftener  in 
6       ■ 


82  ITS  INDISCRIMINATE  ADOPTION 

the  week,  is  the  great  remedy  for  the  ulceration  that  the  doctor  has 
discovered,  and  which  he  assures  his  patient,  and  with  the  most 
perfect  good  faith,  produces  all  the  symptoms  from  which  she  suffers. 
The  caustic  used  in  these  milder  cases  is  the  nitrate  of  silver ;  the 
surface  to  which  it  is  applied  is  covered  by  a  thin  layer  of  albuminous 
secretion,  which  it  is  not  easy  to  remove  completely,  and  which  serves 
greatly  to  diminish  the  power  of  the  agent,  while  the  slightly  stimu- 
lating action  that  it  nevertheless  exerts  seldom  does  harm,  sometimes, 
I  believe,  does  real  good,  though  no  more  than  might  have  been 
equally  attained  by  vaginal  injections,  or  other  similar  remedies, 
which  the  patient  might  have  employed  without  the  intervention  of 
her  medical  attendant. 

There  is  no  more  difficult  problem  in  therapeutical  inquiry  than 
how  to  distinguish  between  the  results  which  really  depend  on  our 
remedies,  and  such  as  only  casually  follow  their  employment.  The 
patient  had  symptoms  of  uterine  ailment ;  the  orifice  of  her  womb 
was  abraded,  caustic  was  applied,  and  the  healing  of  the  abrasion  and 
the  subsidence  of  the  uterine  symptoms  took  place  simultaneously. 
From  these  facts  a  formula  is  framed,  which  is  applied  to  the  manage- 
ment of  uterine  ailments  generally — to  three-fourths  or  four-fifths 
of  the  diseases  of  the  female  sex  that  come  under  the  care  of  the 
practitioner.  So  far,  indeed,  are  these  views  sometimes  carried, 
that  even  the  utter  absence  of  all  signs  of  uterine  disease  is  not 
always  thought  a  sufficient  reason  for  doubting  its  existence ;  but 
examination  with  the  speculum  is  made,  and  the  detection  of  some 
slight  speck  of  abrasion  of  the  os  uteri  is  thought  to  furnish  an 
explanation  of  chronic  ailments  of  the  most  dissimilar  kinds ;  and  a 
panacea  for  those  ills  is  sought  in  the  use  of  the  caustic.  There  are 
those  here  who  can  bear  me  out  in  the  assurance  that  this  is  no 
overcharged  statement ;, but  the  annals  of  medicine  are  full  of  in- 
stances of  the  extent  to  which  preconceived  ideas  modify  the  experi- 
ence of  men  whose  honesty  is  as  much  above  suspicion  as  their  ability 
is  beyond  question  ;  and  no  fellow  of  this  college  will  doubt  the 
integrity  or  the  talent  of  either  of  the  would-be  combatants  who, 
some  hundred  and  twenty  years  ago,  drew  their  swords  in  Cheap- 
side  to  settle  the  proper  treatment  of  the  smallpox. 

It  would  be  a  matter  of  comparatively  little  moment  whether  the 
views  which  I  believe  to  be  erroneous  really  were  so  or  not,  if  they 
led  to  nothing  more  than  an  over-estimate,  on  the  part  of  some 
practitioners,  of  the  value  of  a  certain  kind  of  therapeutical  pro- 


INJURIOUS   TO   PATIENT.  83 

ceeding.     But  their   evil,  if   they  be    erroneous,   does   not   cease 
here ;  they  exert  an  injurious  influence,  both  on  the  patient  and 
the  practitioner.     No  one  engaged  in  the  practice  of  medicine,  but 
must  have  been  often  struck  with  the  important  part  which  the 
sexual  system  plays,  unconsciously  to  herself,   in   almost   all   the 
diseases  of  woman.    The  frequent  sadness  and  low  spirits  in  celibacy, 
the  grief,  the  almost  shame  of  childless  marriage,  depend  on  causes  / 
more  deeply  seated  than  reason  can  dispel,  and  are  familiar  to  us  as  \ 
often  stamping  a  peculiar  character  on  the  diseases  of  our  patients.  « 
To  the  same  cause  is  due  the  nervous  susceptibility  which  women 
often  manifest  on  the  least  symptom  of  ailment  affecting  their  uterine 
system ;  to  control  which,  and  to  prevent  the  disposition  to  uncon- 
scious exaggeration  of  their  symptoms,  becomes  often  one  of  our  ' 
most  important,  and  at  the  same  time  one  of  our  least  easy,  duties,  j 
Any  course  of  proceeding,  then,  which,  without  the  most  urgent  and 
absolute  necessity,  directs  the  patient's  attention  in  the  slighter 
ailments  painfully  and  frequently  to  her  uterine  system,  is  in  the 
highest  degree  objectionable.    The  patient  recovers  from  her  illness, 
but  with  the  impression  that  all  the  sensations  that  for  weeks  or 
months  before  she  had  experienced  were   exclusively  due  to  the 
local  disease  which  had   called  for  local  remedies.     On  the  first 
return  of  any  symptoms  resembling  them,  all  her  apprehensions  are 
revived,  lest  the  same  painful  investigation,  the  same  distressing 
manipulations  as  before,  should  be  again  required.     The  fact  that^ 
it  needs  but  to  watch  the  beatings  of  one's  heart  for  a  few  minutes 
in  order  notably  to  quicken  its  pulsations,  and  to  become  painfully 
conscious  of  its  action,  is  one  of  the  most  familiar  illustrations  of  j 
that  influence  of  attention  upon  the  functions  of  the  body  of  which,  / 
both  in  health  and  in  disease,  we  see  so  many  instances.     Digestion," 
watched  through  its  diff'erent  stages  with  the  not  unnatural  anxiety 
of  a  dyspeptic  invalid,  often  leaves  him  a  hypochondriac,  unable  to 
take  other  than  certain  articles  of  diet,  and  those  cooked  in  some 
peculiar  fashion ;  while  in  many  instances,  neither  in  the  food  itself, 
nor  in  its  mode  of  preparation,  is  there  any  reason  to  be  found  why 
that  alone  should  be  tolerated  by  his  fastidious  stomach.     More  or^ 
less  discomfort — often,  indeed,  much  positive  pain — attends  in  the 
great  majority  of  women  upon  the  performance  of  the  menstrual 
function,  precedes  or  follows  it.     These  pains  are  now  thought  to 
be  of  more  importance  than  before ;  their  occurrence  is  watched 
for,  the  sufl'ering  of  one  month  is  weighed  against  that  of  the  month  ) 


84  INJURIOUS    TO    PATIENT   AND    PRACTITIONER. 


# 


before,  as  the  woman  thinks  she  finds  in  its  increase  or  diminution 
grounds  for  hope  or  for  apprehension.  But  the  sensations  thus 
attended  to  increase  in  intensity  and  in  persistence ;  the  slight  ail- 
ment, which,  but  for  the  coming  evil  that  it  is  supposed  to  portend, 
would  in  a  few  days  be  forgotten,  is  noted  with  anxious  vigilance; 
and  the  more  it  is  observed,  the  more  it  seems  to  grow ;  she  fears 
she  never  shall  be  well  again,  and  at  length  makes  up  her  mind  once 
more  to  go  through  the  same  treatment  as  before  relieved  her,  though 
it  brought  to  her  the  painful  revelation  of  the  grave  cause  on  which 
her  suiFerings,  once  thought  so  little  of,  in  reality  depended.  Such 
persons  among  the  poor  come  to  our  hospitals ;  and  on  questioning 
them  as  to  their  ailments,  they  at  once,  and  without  waiting  to 
describe  their  symptoms,  say  that  they  are  suffering  from  ulceration 
of  the  womb ;  though  on  examination  one  finds  no  trace  of  it,  or  at 
most  a  little  redness  of  the  edges  of  the  os  uteri,  or  it  may  be  even 
that  slight  abrasion  which  I  trust  that  I  have  shown  to  be  as  trivial 
in  importance  as  it  is  frequent  in  occurrence.  But  though  they 
have  no  serious  disease,  they  are  not  the  less,  or  perhaps  one  might 
say  all  the  more,  real  sufferers,  and  sufferers  most  difficult  to  cure. 
The  treatment  they  perhaps  are  once  more  subjected  to  serves  but 
to  confirm  the  morbid  habit  of  mind  which  has  been  gradually 
increasing  upon  them,  and  destroying  both  their  present  happiness 
and  their  capacity  for  it  in  future  years.  They  are  the  victims,  I 
believe,  not  of  the  want  of  honest  purpose  or  of  high  motive  in 
those  who  practise  our  art,  but  of  an  erroneous  opinion. 

This  erroneous  opinion,  however,  reacts  injuriously  upon  the 
practitioner  himself.  He  unlearns  what  physiology  might  teach  him 
of  the  uterus  and  its  functions,  and  sees  in  all  the  varied  manifesta- 
tions of  disorder  the  expression  of  one  fact,  and  of  one  alone  ;  namely, 
the  existence  of  ulceration  of  the  womb,  and  its  reaction  first  on  the 
uterine  system,  then  on  the  general  health.  For  him,  indeed,  there 
is  little  more  to  learn  in  uterine  pathology ;  for  when  once  a  case 
has  been  ascertained  not  to  be  one  of  fibrous  tumour,  polypus, 
or  cancer,  then  ulceration  of  the  os  uteri  is  the  almost  invariable 
cause  to  which  the  symptoms  are  referred,  and  the  cure  of  this 
ulceration  is  the  one  grand  object  at  which  he  endeavours.  All  the 
evils  inseparable  from  the  practice  of  a  specialty  are  thus  aggravated, 
and  the  natural  tendency  of  such  practice  to  subside  into  routine, 
or  to  degenerate  into  empiricism  (I  use  the  word  in  no  invidious 
sense),  becomes  almost  unavoidable. 


OBJECTIONS   TO   THE   USE   OF   THE   STRONGER   CAUSTICS.    B5 

There  was  a  time  in  a  neighbouring  country,  and  not  very  long 
since,  when  the  clue  to  the  understanding  of  all  diseases,  the 
essential  cause  on  which  they  depended,  was  supposed  to  be  Gastro- 
Enteritis.  It  was  conceived  to  be  the  primary  pathological  condition, 
or  proximate  cause  of  fevers,  to  play  a  most  important  part  in  the 
disorders  of  the  cerebral  and  respiratory  systems;  and  all  that 
ingenious  argument  could  do  was  done  by  M.  Broussais  to  support 
his  new  doctrines.  For  years,  France  was  divided  into  two  schools — 
the  supporters  and  the  opponents  of  M.  Broussais's  theories ;  and 
though  truth  was  elicited  by  the  contest,  yet  medical  science  ad- 
vanced during  the  time  much  more  slowly  than,  but  for  these 
divisions,  it  doubtless  would  have  done.  In  the  same  way,  i  believe 
that  the  progress  of  uterine  pathology  has  been  retarded  by  the 
disputes  about  ulceration  of  the  os  uteri ;  for  while  one  party  has 
denied  its  very  existence,  and  another  has  exaggerated  its  import- 
ance, both  have  allowed  numerous  important  questions  to  pass 
"Vv'ithout  even  an  attempt  at  a  reply. 

But  though  it  is  my  conviction  that,  in  the  great  majority  of 
instances  in  which  the  nitrate  of  silver  is  applied  to  the  os  uteri, 
the  proceeding  is  simply  superfluous,  it  yet  would  not  be  right  to 
leave  unnoticed  other  cases  in  which  the  neck  of  the  womb  beins: 
more  or  less  enlarged,  stronger  agents  are  employed.  On  these 
occasions,  the  caustic  potash  is  generally  used,  and  by  some  with 
the  view  of  destroying  outright  a  certain  portion  of  the  enlarged 
cervix,  by  others  with  the  intention  of  getting  rid  of  the  enlarge- 
ment by  means  of  the  inflammation  which  it  sets  up  in  the  uterine 
tissue.  With  whichever  object  resorted  to,  this  proceeding  is  con- 
fessedly devoid  neither  of  sufi'ering  nor  of  danger.  If  the  caustic 
be  introduced,  as  is  usually  done,  within  the  cervical  canal,  it  is 
allowed  that  the  pain  produced,  and  which  sometimes  lasts  for  two 
or  three  days,  is  very  intense,  causing  nausea  or  sickness,  and 
sometimes  even  syncope,  or  occasioning  extreme  depression,  pros- 
trating a  patient  so  completely  as  to  render  her  unable  to  quit  her 
bed  or  sofa  for  several  days.  Thus  much  for  the  present  eff'ect  of 
this  remedy,  for  which  its  strongest  advocates  can  scarcely  lay 
claim  to  such  an  epithet  as  jucunde.  But  it  does  not  fare  much 
better  with  it  as  far  as  cito  is  concerned.  The  application  of  the 
pot~assa  fusa,  so  as  to  produce  an  eschar,  implies  a  subsequent  course 
of  treatment  with  frequent  applications  of  the  nitrate  of  silver  for  a 
period  of  about  forty  days,  at  the  end  of  which  time,  the  action  of 


86  EXCEPTIONAL   CASES 

the  remedy  being  supposed  to  be  exhausted,  unless  the  patient  is 
cured,  it  will  be  necessary  to  repeat  the  same  treatment  again  and 
again.  This  treatment,  too,  it  will  be  observed,  confines  the  patient 
during  the  whole  time  that  it  is  in  progress  to  her  room,  and  almost 
to  her  couch,  and  entails  upon  her  the  necessity  of  one  or  two  ex- 
aminations with  the  speculum  every  week  during  its  continuance. 
But  if  it  can  be  said  to  act  neither  eito  nor  jucunde,  it  might  be 
hoped  that  this  mode  of  proceeding  had  at  least  the  third  merit  of 
tuto  ;  but  it  has  not.  The  tendency  to  contraction  or  obliteration 
of  the  cervical  canal  after  these  proceedings  is  very  considerable, 
and  is  referred  to  even  as  a  frequent  occurrence,  while  inflammation, 
both  of  the  uterus  generally,  and  of  its  appendages,  is  a  contingency 
far  from  uncommon.  Of  the  last  of  these  accidents  I  have  seen 
several  instances  among  patients  at  the  'Hospital,  who,  previous  to 
their  coming  under  my  care,  had  been  treated  with  the  stronger 
caustics  for  ulceration  of  the  os  uteri. 

I  will  not  attempt  to  follow  the  advocates  of  this  puactice  through 
the  explanation  which  they  give  of  its  mode  of  action;  and  the 
rather,  since  where  some  see  a  healthy  stimulus  to  the  affected 
tissues,  others  discern  what  they  consider  to  be  a  dulling,  stupefying 
influence,  as  they  term  it,  weakening  the  vital  force  ;  while,  through- 
out the  language  used  with  reference  to  this  subject,  there  is  a 
mingling  of  metaphor  with  scientific  terminology,  from  which  it  is 
extremely  difficult  to  arrive  at  a  clear  notion  of  what  is  meant.  I 
do  not  doubt  but  that,  by  either  mode  of  applying  the  caustic  potass, 
the  cervix  uteri  may  be  reduced  in  size ;  but  my  dissent  from  the 
practice  is  founded  on  the  fact  that  it  has  none  of  the  three  recom- 
mendations of  painlessness,  speed,  or  safety ;  while  my  own  experience 
would  lead  me  to  believe  that,  when  adopted,  it  is  usually  either  out 
of  place  or  superfluous.  During  the  presence  of  any  active  symptom 
of  inflammation,  such  a  proceeding  as  the  destruction  of  a  portion  of 
the  uterine  tissue  by  caustics  cannot  but  be  perilous ;  after  their 
removal,  the  womb  will  return  slowly,  often  indeed  but  imperfectly, 
to  its  previous  size.  This  return,  however,  does  take  place,  as  far 
at  least  as  my  experience  goes,  in  the  immense  majority  of  cases ; 
and  takes  place  as  surely,  and  not  much  more  slowly,  under  just 
those  conditions  which  best  promote  the  general  health,  as  under  a 
course  of  treatment  which,  apart  from  other  evils,  confines  a  woman 
for  weeks  and  months  to  her  chamber  and  her  couch,  to  the  grievous 
impairment  of  her  general  health,  and  the  utter  ruin  of  her  cheerful- 


JUSTIFYING   LOCAL   TREATMENT.  87 

ness,  as  o»  several  occasions  I  have  had  the  opportunity  of  observ- 
ing. Moreover,  very  wide  variations  in  the  size  of  the  womb  seem  to 
be  equally  compatible  with  the  healthy  performance  of  its  functions; 
while  the  special  tendency  which  it  exhibits,  under  any  circumstances 
that  produce  congestion  of  its  vessels  to  increase  in  size,  must  never 
be  forgotten  in  estimating  the  pathological  importance  of  hypertro- 
phy, either  of  the  whole  or  of  a  part  of  the  organ.  In  this  opinion, 
too,  I  am  further  strengthened  by  the  fact  that  some  of  the  most 
marked  instances  of  enlargement  of  the  neck  of  the  womb,  with 
increased  hardness  of  its  tissue,  which  have  come  under  my  observa- 
tion, occurred  in  cases  where  there  was  no  trace  of  ulceration  either 
of  the  OS  uteri  or  of  the  canal  of  its  cervix. 

At  the  same  time  there  are  some  exceptional  cases,  which  I  have 
already  referred  to,  where  ulceration,  or  some  allied  morbid  condition 
of  the  OS  uteri,  is  found  to  exist  independent  of  any  appreciable 
disease  elsewhere ;  and  others,  equally  rare,  in  which,  after  symp- 
toms of  uterine  ailment  have  been  subdued,  a  morbid  state  of  the 
OS  uteri  persists,  which  is  benefited  by  stimulant  applications.  In 
such  cases,  I  use  either  the  nitrate  of  silver  or  the  acid  nitrate  of 
^mercury,  though  neither  of  them  frequently ;  and  for  weeks  together 
no  case  appears  among  my  patients  at  St.  Bartholomew's  Hospital 
in  which  the  employment  of  either  appears  to  me  indicated.  In 
justice  to  others,  it  should,  I  think,  be  observed,  that  we  have  no 
right  to  infer  that  the  majority  of  practitioners,  who  resort  to  those 
agents  with  much  greater  frequency  than  some  of  us  feel  warranted 
in  doing,  regard  them  as  absolutely  the  best  remedies  that  could  be 
used,  but  merely  as  the  best  under  the  peculiar  circumstances  in 
which  uterine  diseases  have  to  be  treated.  Were  it  possible  to  keep 
any  of  those  milder  agents  in  contact  with  the  abraded  os  uteri, 
which  can  generally  be  applied  to  an  irritated  or  ulcerated  surface 
elsewhere,  this  would  doubtless  be  allowed  in  many  instances  to  be 
a  preferable  proceeding.  The  problem,  however,  is  to  find  some 
agent  sufficiently  powerful  to  exert  an  influence  which  may  continue 
for  several  days,  and  thus  to  obviate  the  necessity  fo'P  that  frequent 
painful  interference  which  would  otherwise  be  required.  That  lo- 
tions, batks,  and  other  remedial  agents  which  may  be  safely  intrusted 
to  the  patient  herself,  will  answer  the  desired  ends  more  frequently 
than  some  practitioners  imagine,  is  my  firm  conviction ;  but  I  could 
not  refrain  from  stating  what  seems  to  me  to  be  the  candid  interpre- 
tation of  their  conduct  who  pursue  a  different  course  of  proceeding. 


88  CONCLUSION. 

Time  forbids  that  I  should  enter  into  further  detail — nor,  indeed, 
does  my  subject  need  it;  for  I  proposed  to  myself  only  "  To  inquire 
into  the  Pathological  Importance  of  Ulceration  of  the  Os  Uteri." 
In  doing  this,  I  have  had  of  necessi1:y  to  refer  to  opinions  from 
which  I  diifered.  It  was  no  want  of  respect  for  many  of  those  who 
entertain  those  opinions,  and  whose  talents  have  done  so  much  to 
render  them  popular,  which  has  led  me  studiously  to  abstain  from 
referring  to  them  by  name ;  but  I  believe,  and  have  high  authority 
for  acting  on  the  belief,  that  "  The  cause  of  truth  gains  much  by  a 
course,  which  not  only  avoids  personal  controversy,  but  confines 
attention  to  the  real  merits  of  the  case,  independently  of  the  ex- 
traneous circumstances  which  ought  not  to  influence  the  decision." 

I  have  treated  this  inquiry,  Sir,  into  what  is  after  all  but  a  com- 
paratively small  ailment,  as  gravely  as  though  it  were  one  of  those 
dire  diseases,  in  the  study  and  the  cure  of  which  the  highest  skill  of 
the  greatest  votaries  of  our  art  has  found  its  fit  employment.  But 
you  will  not  blame  me,  I  trust,  for  this :  the  thousand  smaller  ills 
to  which  mankind  is  subject  bring,  in  their  frequent  repetition,  as 
much  suiFering,  cause  as  much  sorrow,  and  therefore  are  as  worthy 
or  our  heartiest  labour  to  understand,  and  of  our  best  efforts  to 
relieve,  as  those  perilous  visitants — inflammations,  fevers,  apoplex- 
ies, which  threaten  life  only  at  long  intervals  or  on  rare  occasions. 
If,  however,  it  should  still  seem  to  any  that  I  have  chosen  a  theme 
beneath  the  dignity  of  this  College,  may  I  remind  them  that  Syden- 
ham himself  has  told  us,  he  should  not  deem  his  life  ill-spent  if  he 
had  contributed  to  even  the  least  improvement  in  the  very  humblest 
branches  of  practical  medicine  ;^  and,  taking  shelter  behind  his  great 
name,  plead  in  extenuation  of  my  poor  performance,  "  Quantacum- 
que  fuerint  aliorum  conamina,  semper  existimavi  mihi  vitalis  auras 
usum  frustra  datum  fore,  nisi  ^t  ipse  in  hoc  stadio  versatus  symbolam 
aliquam  utcunque  exiguam  in  commune  medicinse  aerarium  contri- 
buerim." 

^  <'Etsi  nihil  magnificentius,"  says  he,  "quam  odontalgiae,  aut  clavorum  pedibus 
iunascentium  curatio." 


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illustrations.     {Now  Ready.) 

There  was  still  wanting  some  book  which  should  who  resolves  to  pursue  for  himself  a  steady  search 
aid  the  young  analytical  chemist  through  all  the  into  the  chemical  mysteries  of  creation.  For  such 
phases  of  the  science.  The  "  Handbook"  of  Messrs.  ■  a  student  the  'Handbook'  will  prove  an  excellent 
Abel  and  Bloxam  appears  to  supply  that  want.  As  '  guide,  since  he  will  find  in  it,  not  merely  the  most 
Dr.  Hofmann  says  in  his  brief  Preface,  "  The  pre-  approved  modes  of  analytical  investigation,  but 
sent  volume  is  a  synopsis  of  their  (the  authors')  ex-  ■  descriptions  of  the  apparatus  necessary,  with  such 
perience  in  laboratory  teaching  ;  it  gives  the  neces-  ;  manipulatory  details  as  rendered  Faraday's  '  Che- 
sary  instruction  in  chemical  manipulation,  a  concise  j  mical  Manipulations'  so  valuable  at  the  time  of  its 
account  of  general  chemistry  as  far  as  it  is  involved  I  publication.  Beyond  this,  the  importance  of  the 
in  the  operations  of  the  laboratory,  and  lastly,  quali-  work  is  increased  by  the  introduction  of  much  of  the 
tative  and  quantitative  analysis.  It  must  be  under-  technical  chemistry  of  the  manufactory." — Athe- 
stood  that  this  is  a  work  fitted  for  the  earnest  student,  '  nceum. 


ASHWELL   (SAMUEL),   M.  D. 
A  PRACTICAL  TREATISE  ON  THE  DISEASES  PECULIAR  TO  WOMEN. 

Illustrated  by  Cases  derived  from  Hospital  and  Private  Practice.     With  Additions  by  Paul  Beck 
GoDDARD,  M.  D.     Second  American  edition.     la  one  octavo  volume,  of  520  pages. 


ARNOTT   (NEILL),  M.  D. 
ELEMENTS    OF    PHYSICS;    or  Natural  Philosophy,  General  and  Medical. 

Written  for  universal  use,  in  plain  or  non-technical  language.    A  new  edition,  by  Isaac  Hays, 
M.  D.     Complete  in  one  octavo  volume,  of  484  pages,  with  about  two  hundred  illustrations. 


BENNETT   (J.    HUGHES),    M.  D.,    F.  R.  S.  E., 

Professor  of  Clinical  Medicine  in  the  University  of  Edinburgh,  &c. 

THE  PATHOLOGY  AND   TREATMENT  OF  PULMONARY  TUBERCU- 

LOSIS,  and  on  the  Local  Medication  of  Pharyngeal  and  Laryngeal  Diseases  frequently  mistakea 
for  or  associated  with,  Phthisis.  In  one  handsome  octavo  volume,  with  beaulilul  wood-cuts. 
{Now  Ready.) 


How  it  may  be  most  effectually  carried  into  prac- 
tice, our  readers  will  learn  from  Dr.  Bennett's  pages, 
especially  from  the  histories  of  the  valuable  and  in- 
teresting cases  which  he  records.  Indeed,  if  the  au- 
thor had  only  reported  these  cases  he  would  have 
benefited  his  profession,  and  deserved  our  thanks.  As 
it  is,  however,  his  whole  volume  is  so  replete  with 
valuable  matter,  that  we  feel  bound  to  recommend 
our  readers,  one  and  all,  to  peruse  it. — Lond.  Lancet. 


The  elegant  little  treatise  before  us  shows  how 
faithfully  and  intelligently  these  investigations  have 
been  pursued,  and  how  successfully  the  author's 
studies  have  resul  ted  in  clearing  up  some  Qf  the  most 
doubtful  points  and  conflicting  doctrines  hitherto 
entertained  in  reference  to  the  history  and^reatment 
of  pulmonary  tuberculosis. — N.  Y.  Journal  of  Medi- 
cal and  Collateral  Science,  March,  1851. 


BENNETT   (HENRY),  M.  D. 
A  PRACTICAL   TREATISE    ON   INFLAMMATION  OF  THE  UTERUS, 

ITS  CERVIX  AND   APPENDAGES,  and  on  its  connection  with  Uterine  Disease.     Fourth 

American,  from  the  third  and  revised  London  edition.     In  one  neat  octavo  volume,  of  430  pages, 

with  wood-cuts.     {Now  Ready.) 

This  edition  will  be  found  materially  improved  over  its  predecessors,  the  author  having  carefully 
revised  it,  and  made  considerable  additions,  amounting  to  about  seventy-five  pages. 

This  edition  has  been  carefully  revised  and  altered,     that  the  bulk  of  the  profession  are  not  fully  alive  to 
and  various  additions  have  been  made,  which  render     the  importance  and  frequency  of  the  disease  of  which 

it  more  complete,  and,  if  possible,  more  w^orthy  of      -^   '-  •"■  

the  high  appreciation  in  which  it  is  held  by  the 
medical  profession  throughout  the  world.  A  copy 
stiould  be  in  the  possession  of  every  physician. — 
Charleston  Med.  Journal  and  Review,  March,  1854. 

We  are  firmly  of  opinion  that  in  proportion  as  a 
knowledge  of  uterine  diseases  becomes  more  appre- 
ciated, this  work  will  be  proportionably  established 
as  a  text-book  in  the  profession. — The  Lancet. 


it  takes  cognizance.  The  present  edition  is  so  much 
enlarged,  altered,  and  improved,  that  it  can  scarcely 
be  considered  the  same  work.— Dr.  Ranking^s  Ab- 
stract. 


Few  works  issue  from  the  medical  press  which 

i  are  at  once  original  and  sound  in  doctrine  ;  but  such, 

I  we  feel  assured,  is  the  admirable  treatise  now  before 

I  us.     The   important  practical  precepts  which   the 

author  inculcates  are  all  rigidly  deduced  from  facts. 

When,  a  few  years  back,  the  first  edititm  of  the  1  .  .  •  Every  page  of  the  book  is  good,  and  eminently 

present  work  was  published,  the  sul)ject  was  one  al-  ^  practical.  ...  So  far  as  we  know  and  believe,  it  is 

most  entirely  unknown  to  the  obstetrical  celebrities  !  the  best  work  on  the  subject  of  which  it  treats. — 

of  the  day  ;  and  even  now  we  have  reason  to  know    Monthly  Journal  of  Medical  Science. 


BLANCHARD   &   LEA'S   MEDICAL 


BEALE  (LIONEL    JOHN),  M.  R.  C.  S.,  &,c. 
THE    LAWS   OF    HEALTH   IN   RELATION   TO    MIND    AND   BODY. 

A  Series  of  Letters  from  an  old  Practitioner  to  a  Patient.     In  one  handsome  volume,  royal  12mo.. 
extra  cloth. 


BILLING    (ARCHIBALD),  M.  D. 
THE  PRINCIPLES  OF  MEDICINE.     Second  American,  from  the  Fifth  and 
Improved  London  edition.     In  one  handsome  octavo  volume,  extra  cloth,  250  pages. 


BLAKISTON    (PEYTON),  M.  D.,  F.  R.  S.,  &.C. 
PRACTICAL    OBSERVATIONS    ON    CERTAIN    DISEASES    OF    THE 

CHEST,  and  on  the  Principles  of  Auscultation.    In  one  volume,  8vo.,  pp.  384. 


BURROWS    (GEORGE),  M.  D. 
ON  DISORDERS  OF  THE  CEREBRAL   CIRCULATION,  and  on  the  Con- 
nection between  the  Affections  of  the  Brain  and  Diseases  of  the  Heart.    In  one  8vo.  vol.,  with 
colored  plates,  pp.  21t). 

BUDD  (GEORGE),  M.  D.,  F.  R.  S., 

Professor  of  Medicine  in  King's  College,  London. 

ON   DISEASES   OF   THE   LIVER.     Second  American,  from  the  second  and 

enlarged  London  edition.     In  one  very  handsome  octavo  volume,  with  four  beautifully  colored 
plates,  and  numerous  wood-cuts.    pp.  468.    New  edition.     {Just  Issued.) 

The  reputation  which  this  work  has  obtained  as  a  full  and  practical  treatise  on  an  important  class 
of  diseases  will  not  be  diminished  by  this  improved  and  enlarged  edition.  It  has  been  carefully  and 
thoroughly  revised  by  the  author ;  the  number  of  plates  has  been  increased,  and  the  style  of  its  me- 
chanical execution  will  be  found  materially  improved. 


The  full  digest  we  have  given  of  the  new  matter 
introduced  into  the  present  volume,  is  evidence  of 
the  value  we  place  on  it.  The  fact  that  the  profes- 
sion has  required  a  second  edition  of  a  monograph 
such  as  that  before  us,  bears  honorable  testimony 
to  its  usefulness.      For  many  years,  Dr.  Budd's 


work  must  be  the  authority  of  the  great  mass  of 
British  practitioners  on  the  hepatic  diseases  ;  and  it 
is  satisfactory  that  the  subject  has  been  taken  up  by 
so  able  and  experienced  a  physician. — British  and 
Foreign  Medic o-Chirurgical  Review. 


BUSHNAN  (J.  S.),    M.  D. 
THE  PHYSIOLOGY  OF   ANIMAL  AND  VEGETABLE  LIFE:  a  Popular 

Treatise  on  the  Functions  and  Phenomena  of  Organic  Life.  To  which  is  prefixed  a  Brief  Expo- 
sition of  the  great  departments  of  Human  Knowledge.  In  one  handsome  royal  12mo.  volume, 
with  over  one  hundred  illustrations. 

Though  cast  in  a  popular  form  and  manner,  this  work  is  the  production  of  a  man  of  science,  and 
presents  its  subject  in  its  latest  development,  based  on  truly  scientific  and  accurate  principles. 
It  may  therefore  be  consulted  with  interest  by  those  who  wish  to  obtain  in  a  concise  form,  and  at 
a  very  low  price,  a  resume  of  the  present  state  of  animal  and  vegetable  physiology. 


BLOOD  AND  URINE  (MANUALS  ON). 
BY  JOHN  WILLIAM   GRIFFITH,   G.  OWEN  REESE,   AND  ALFRIID 

MARKWICK.     One  thick  volume,  royal  12mb.,  extra  cloth,  with  plates,     pp.  460. 

BRODIE  (SIR  BENJAMIN   C),  M.  D.,  &c. 
Ca:iD^ICAL  LECTURES  ON  SURGERY.     1  vol.  8vo.,  cloth.     850  pp. 

BY   THE   SAME    AUTHOR. 

SELECT  SURGICAL  WORKS,  1  vol.  8vo.  leather,  containing  Clinical  Lectures 

on  Surgery,  Diseases  of  the  Joints,  and  Diseases  of  the  Urinary  Organs. 


URINARY     DEPOSITS:     THEIR     DIAGNOSIS,    PATHOLOGY,    AND 

THEllAPEUTICAL  INDICATIONS.     A  new  and  enlarged  American,  from  the  last  improved 
London  edition.     With  over  sixty  illustrations.     In  one  royal  12ino.  volume,  extra  cloth. 


The  n<nv  edition  of  Dr.  Bird's  work,  though  not 
increased  in  size,  has  been  greatly  modified,  and 
much  of  it  rewritten.  It  now  presents,  in  a  corn- 
p^endious  form,  the  gist  of  all  that  is  known  and  re- 
iiable  in  this  department.  From  its  terse  style  and 
convenient  size,  it  is  particularly  applicable  to  the 
Btadent,  to  whom  we  cordially  commend  it. — The 
Medical  Examiner.  ^ 

It  can  scarcely  be  necessary  for  us  to  say  anything 
of  the  merits  of  this  well-known  Treatise,  wiiich  so 
admirably  brings  into  practical  application  the  re- 


sults of  those  microscopical  and  chemical  researches 
regarding  the  physiology  and  pathology  of  the  uri- 
nary secretion,  which  nave  contributed  so  much  to 
the  increase  of  our  diagnostic  powers,  and  to  tine 
extension  and  satisfactory  employment  of  our  thera- 
peutic resources.  In  the  preparation  of  this  new 
edition  of  his  work,  it  is  obvious  that  Dr.  Golding 
Bird  has  spared  no  pains  to  render  it  a  faithful  repre- 
sentation of  the  present  state  of  scientific  knowledofo 
on  the  subject  it  emhrRces.— The  British  and  Foreign 
Medico- C hirurgical  Review. 


BY   THE   SAME   AUTHOR. 

ELEMENTS  OF  NATURAL  PHILOSOPHY;  being  an  Experimental  Intro- 
duction to  the  Physical  Sciences.  Illustrated  with  nearly  four  hundred  wood-cuts.  From  the 
third  London  edition.    In  one  neat  volume,  royal  r2mo.    pp.  402. 


AND   SCIENTIFIC    PUBLICATIONS. 


BARTLETT  (ELISHA),  M.  D., 

ProfcBSor  of  Materia  Medica  and  Medical  Jurisprudence  in  the  College  of  Physicians  and 

Surgeons,  New  York. 

THE  HISTOKY,  DIAaNOSIS,  AND  TREATMENT  OF  THE  FEVERS 

OF  THE  UNITED  STATES.    Third  edition,  revised  and  improved.    In  one  octavo  volume, 

of  six  hundred  pages,  beautifully  printed,  and  strongly  bound. 

In  preparing  a  new  edition  of  this  standard  work,  the  author  has  availed  himself  of  such  obfter- 
vations  and  investigations  as  have  appeared  since  the  publication  of  his  last  revision,  and  he  has 
endeavored  in  every  way  to  render  it  worthy  of  a  continuance  of  the  very  marked  favor  with  which 
it  has  been  hitherto  received. 


The  masterly  and  elegant  treatise,  by  Dr.  Bartlett 
is  invaluable  to  the  American  student  and  practi- 
tioner.— Dr.  Holmes''s  Report  to  the  Nat.  Med.  Asso- 
tiation. 

We  regard  it,  from  the  examination  we  have  made 
of  it,  the  best  work  on  fevers  extant  in  our  language, 
Rnd  as  such  cordially  recommend  it  to  the  medical 
public. — St.  Louis  Medical  and  Surgical  Journal. 

Take  it  altogether,  it  is  the  m»st  complete  history 
of  our  fevers  which  has  yet  been  published,  and 
every  practitioner  should  avail  himself  of  its  con- 
teats. —  The  Western  Lancet. 


Of  the  value  and  importance  of  such  a  work,  it  i« 
needless  here  to  speak ;  the  profession  of  the  United 
States  owe  much  to  the  author  for  the  very  able 
volume  which  he  has  presented  to  them,  and  for  the 
careful  and  judicious  manner  in  which  he  has  exe- 
cuted his  task.  No  one  volume  with  which  we  arc 
acquainted  contains  so  complete  a  history  of  our 
fevers  as  this.  To  Dr.  Bartlett  we  owe  our  best 
thanks  for  the  very  able  volume  he  has  given  us,  as 
embodying  certainly  the  most  complete,  methodical, 
and  satisfactory  account  of  our  fevers  anywhere  to 
be  met  with.— The  Charleston  Med.  Journal  and 
Review. 


BUCKLER  (T.  H.),  M.  D., 

Formerly  Physician  to  the  Baltimore  Almshouse  Infirmary,  &c. 

ON  THE  ETIOLOGY,  PATHOLOGY,  AND  TREATMENT  OF  FIBRO- 

BRONCHITIS  AND  KHEUMATIC  PNEUMONIA.    In  one  handsome  octavo  volume,  extra 
cloth.     (Just  Isstted.)  ''■'^ 

BOWMAN  (JOHN   E.),  M.D. 
PRACTICAL   HANDBOOK   OF   MEDICAL    CHEMISTRY.     In  one  neat 

volume,  royal  12mo.,  with  numerous  illustrations,     pp.  288. 

BY  THE  SAME  AUTHOR.  "^ 

INTRODUCTION    TO    PRACTICAL    CHEMISTRY,    INCLUDING   ANA- 

LYSIS.    With  numerous  illustrations.    In  one  neat  volume,  royal  12mo.     pp.350. 


BARLOW   (GEORGE  H.),   M.  D. 
A  MANUAL  OF  THE  PRINCIPLES  AND  PRACTICE   OF  MEDICINE. 

In  one  octavo  volume.     {Preparing.) 


CYGLOP/EDIA    OF    PRACTICAL    MEDICINE. 
Edited  by  Dunglison,  Forbes,  Tweedie,  and  Conolly,  in  four  large  octavo 
volumes,  strongly  bound.     "S^  See  Dunglison. 


COLOMBAT  DE  L'ISERE.  .^i 

A  TREATISE   ON   THE    DISEASES    OF   FEMALES,  and  on  the  Speciil 

Hygiene  of  their  Sex.  Translated,  with  many  Notes  and  Additions,  by  C.  D.  Meigs,  M.  D. 
Second  edition,  revised  and  improved.  In  one  large  volume,  octavo,  with  numerous  wood-cuts, 
pp.  720. 

Tlie  treatise  of  M.  Colombat  is  a  learned  and  la-  i  M.  Colombat  De  L'lsere  has  not  consecrated  ten 
borious  commentary  on  these  diseases,  indicating  |  years  of  studious  toil  and  research  to  the  frailer  sex 
very  considerable  research,  great  accuracy  of  judg-  j  in  vain;  and  although  we  regret  to  hear  it  is  at  the 
ment,  and  no  inconsiderable  personal  experience,  expense  of  health,  he  has  imposed  a  debt  of  gratitude 
With  the  copious  notes  and  additions  of  its  experi-  I  as  well  upon  the  profession,  as  upon  the  mothers  and 


eaiced  and  very  erudite  translator  and  editor,  Dr 
Meigs,  it  presents,  probably,  one  of  the  most  com- 
plete and  comprehensive  works  on  the  subject  we 
possess. — American  Med.  Journal. 


daughters  of  beautiful  France,  which  that  gallant 
nation  knows  best  how  to  acknowledge. — New  Or- 
leans Medical  Journal. 


COPLAND  (JAMES),  M.  D.,  F.  R.S.,  8cc. 
OF   THE   CAUSES,  NATURE,  AND   TREATiMENT   OF    PALSY    AND 

APOPLEXY,  and  of  the  Forms,  Seats,  Complications,  and  Morbid  Relations  of  Paralytic  and 
Apoplectic  Diseases.    In  one  volume,  royal  12mo.,  extra  cloth,    pp.  326. 


CLYMER  (MEREDITH),  M.  D.,  5tc. 
FEVERS;     THEIR    DIAGNOSIS,    PATHOLOOY,    AND    TREATMENT. 

Prepared  and  Edited,  with  large  Additions,  from  the  Essays  on  Fever  in  Tweedie's  Libi-ary  ^ 
Practical  Medicine.     In  one  octavo  volume,  of  600  pages. 


CARSON  (JOSEPH),  M.  D., 

Professor  of  Materia  Medica  and  Pharmacy  in  the  University  of  Pennsylvania.  'H 

SYNOPSIS  OF  THE  COURSE  OF  LECTURES  ON  MATERIA  MEDICJS; 

AND  PHARMACY,  delivered  in  the  University  of  Pennsylvania.    In  one  very  neat  octavo 
volume,  of  208  pages. 


BLANCHARD  &  LEA'S   MEDICAL 


CARPENTER  (WILLIAM    B.),   M.  D.,  F.  R.  S.,  &.C., 

Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  London. 

PRINCIPLES  OF  HUMAN  PHYSIOLOGY;  with  their  chief  applications  to 

Psychology,  Pathologv,  Therapeutics,  Hygiene,  and  Forensic  Medicine.  Fifth  American,  from 
the  fourth  and  enlarged  London  edition.  With  three  hundred  and  fourteen  illustrations.  Edited, 
with  additions,  by  Francis  Gurney  Smith,  M.  D.,  Professor  of  the  Institutes  of  Medicine  in  the 
Pennsylvania  Medical  College,  &c.  In  one  very  large  and  beautiful  octavo  volume,  of  about  1100 
large  pages,  handsomely  printed  and  strongly  bound  in  leather,  with  raised  bands.  New  edition. 
{Lately  Issued.) 


The  most  complete  work  on  the  science  in  our 
language.— ^w.  Med.  Journal. 

The  most  complete  exposition  of  physiology  which 
any  language  can  at  present  give. — Brit,  and  For. 
Med.-Chirurg.  Review. 

We  have  thus  adverted  to  some  of  the  leading 
"additions  and  alterations,"  which  have  been  in- 
troduced by  the  author  into  this  edition  of  his  phy- 
siology. These  will  be  found,  however,  very  far  to 
exceed  the  ordinary  limits  of  a  new  edition,  "  the 
old  materials  having  been  incorporated  with  the 
new,  rather  than  the  new  with  the  old."  It  now 
certainly  presents  the  most  complete  treatise  on  the 
subject  within  the  reach  of  the  American  reader  ; 
and  while,  for  availability  as  a  text-book,  we  may 
perhaps  regret  its  growth  in  bulk,  we  are  sure  that 
the  student  of  physiology  will  feel  the  impossibility 
of  presenting  a  thorough  digest  of  the  facts  of  the 
science  within  a  more  limited  compass. — Medical 
Examiner. 

The  greatest,  the  most  reliable,  and  the  best  book 
(Ml  the  subject  which  we  know  of  in  the  English 
language. — Stethoscope. 

The  most  complete  work  now  extant  in  our  lan- 
guage.— N.  O.  Med.  Register. 

The  changes  are  too  numerous  to  admit  of  an  ex- 
tended notice  in  this  place.  At  every  point  where 
the  recent  diligent  labors  of  organic  chemists  and 
micrographers  have  furnished  interesting  and  valu- 
able facts,  they  have  been  appropriated,  and  no  pains 
have  been  spared,  in  so  incorporating  and  arranging 
them  that  the  work  may  constitute  one  harmonious 
system. — Southern  Med.  and  Surg.  Journal. 


The  best  text-book  in  the  language  on  this  ex- 
tensive subject. — London  Med.  Times. 

A  complete  cyclopsedia  of  this  branch  of  science. 
—N.  Y.  Med.  Times. 

The  standard  of  authority  on  physiological  sub- 
jects. *  *  *  In  the  present  edition,  to  particularize 
the  alterations  and  additions -which  have  been  made, 
would  require  a  review  of  the  whole  work,  since 
scarcely  a  subject  has  not  been  revised  and  altered, 
added  to,  or  entirely  remodelled  to  adapt  it  to  the 
present  state  of  the  science. — Charleston  Med.  .Tourn. 

Any  reader  who  desires  a  treatise  on  physiology 
may  feel  himself  entirely  safe  in  ordering  this. — 
Western  Med.  and  Surg.  Journal. 

From  this  hasty  and  imperfect  allusion  it  will  be 
seen  by  our  readers  that  the  alterations  and  addi- 
tions to  this  edition  render  it  almost  a  new  work — 
and  we  can  assure  our  readers  that  it  is  one  of  the 
best  summaries  of  the  existing  facts  of  physiological 
science  within  the  reach  of  the  English  student  and 
physician. — N.  Y.  Journal  of  Medicine. 

The  profession  of  this  country,  and  perhaps  also 
of  Europe,  have  anxiously  and  for  some  time  awaited 
the  announcement  of  this  new  edition  of  Carpenter's 
Human  Physiology.  His  former  editions  have  for 
many  years  been  almost  the  only  text-book  on  Phy- 
siology in  all  our  medical  schools,  and  its  circula- 
tion among  the  profession  has  been  unsurpassed  by 
any  work  in  any  department  of  medical  science. 

It  is  quite  unnecessary  for  us  to  speak  of  thig 
work  as  its  merits  would  justify.  The  mere  an- 
nouncement of  its  appearance  will  afford  the  highest 
pleasure  to  every  student  of  Physiology,  while  its 
perusal  will  be  of  infiuite  service  in  advancing 
physiological  science. — Ohio  Med.  and  Surg.  Journ. 


BY    THE   SAME   AUTHOR.      (NoW  Ready.) 

PRINCIPLES  OF  COMPARATIVE   PHYSIOLOGY.     New  American,  from 

the  Fourth  and  Revised  London  edition.     In  one  large  and  handsome  octavo  volume,  with  oA'er 
three  hundred  beautiful  illustrations. 

The  delay  which  has  existed  in  the  appearance  of  this  work  has  been  caused  by  the  very  thorough 
revision  and  remodelling  which  it  has  undergone  at  the  hands  of  the  author,  and  the  large  number 
of  new  illustrations  which  have  been  prepared  for  it.  It  will,  therefore,  be  found  almost  a  new 
work,  and  fully  up  to  the  day  in  every  department  of  the  subject,  rendering  it  a  reliable  text-book 
for  all  students  engaged  in  this  branch  of  science.  Every  effort  has  been  made  to  render  its  typo- 
graphical finish  and  mechanical  execution  worthy  of  its  exalted  reputation,  and  creditable  to  the 
mechanical  arts  of  this  country.     A  few  notices  of  the  last  edition  are  appended. 

critical,  and  unprejudiced  view  of  those  labors,  and 


Without  pretending  to  it,  it  is  an  Encyclopedia  of 
the  subject,  accurate  and  complete  in  all  respects — 
a  truthful  reflection  of  the  advanced  state  at  which 
the  science  has  now  arrived. — Dublin  Quarterly 
Journal  of  Medical  Science. 

A  truly  magnificent  work— in  itself  a  perfect  phy- 
siological study. — Ranking^s  Abstract. 

This  work  stands  without  its  fellow.  It  is  one 
few  men  in  Europe  could  have  undertaken  ;  it  is  one 
no  man,  we  believe,  could  have  brought  to  so  suc- 
cessful an  issue  as  Dr.  Carpenter.  It  required  for 
its  production  a  physiologist  at  once  deeply  read  in 
the  labors  of  others,  capable  of  taking  a  general, 


of  combining  the  varied,  heterogeneous  materials  at 
his  disposal,  so  as  to  form  an  harmonious  whole. 
We  feel  that  this  abstract  can  give  the  reader  a  very 
imperfect  idea  of  the  fulness  of  this  work,  and  no 
idea  of  its  unity,  of  the  admirable  manner  in  which 
material  has  been  brought,  from  the  most  various 
sources,  to  conduce  to  its  completeness,  of  the  lucid- 
ity of  the  reasoning  it  contains,  or  of  the  clearness 
of  language  in  which  the  whole  is  clothed.  Not  the 
profession  only,  but  the  scientific  world  at  large, 
must  feel  deeply  indebted  to  Dr.  Carpenter  for  this 
great  work.  It  must,  indeed,  add  largely  even  to 
his  high  reputation. — Medical  Times. 


BY  THE  SAME  AUTHOR.     (Prepari7ig .) 

THE  MICROSCOPE  AND  ITS  REVELATIONS.     In  one  handsome  volume, 

beautifully  illustrated  with  plates  and  wood-cuts. 

BY  THE  SAME  AUTHOR.     {Preparing.) 

GENERAL  PHYSIOLOG-Y.     In  one  large  and  very  handsome  octavo  volume, 
with  several  hundred  illustrations. 

The  subject  of  general  physiology  having  been  omitted  in  the  last  edition  of  Ihe  author's  "  Com- 
parative Physiology,"  he  has  undertaken  to  prepare  a  volume  which  shall  present  it  more  tho- 
roughly and  fully  than  has  yet  been  attempted,  and  which  may  be  regarded  as  an  introduction  to 
his  other  works.' 


^  j^4  04'J.  iw  ^.tuiii\m 


AND   SCIENTIFIC   PUBLICATIONS. 


CARPENTER  (WILLIAM  B.),   M.  D.,  F.  R.  S., 

Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  London. 

ELEMENTS  (OR  MANUAL)  OF  PHYSIOLOGY,  INCLUDINa  PHYSIO- 
LOGICAL ANATOMY.  Second  American,  from  a  new  and  revised  London  edition.  With 
one  hundred  and  ninety  illustrations.     In  one  very  handsome  octavo  volume. 

In  publishing  the  first  edition  of  this  vv^ork,  its  title  was  altered  from  that  of  the  London  volume, 
by  the  substitution  of  the  word  "Elements"  for  that  of  "  Manual,"  and  with  the  author's  sanction 
the  title  of  "Elements"  is  still  retained  as  being  more  expressive  of  the  soope  of  the  treatise.  A 
comparison  of  the  present  edition  with  the  former  one  will  show  a  material  improvement,  the 
author  having  revised  it  thoroughly,  with  a  view  of  rendering  it  completely  on  a  level  with  the 
most  advanced  state  of  the  science.  By  condensing  the  less  important  portions,  these  numerous 
additions  have  been  introduced  without  materially  increasing  the  bulk  of  the  volume,  and  while 
numerous  illustrations  have  been  added,  and  the  general  execution  of  the  work  improved,  it  has 
been  kept  at  its  former  very  moderate  price. 


To  say  that  it  is  the  best  manual  of  Physiology 
now  before  the  public,  would  not  do  sufficient  justice 
to  the  author. — Buffalo  Medical  Journal. 

In  his  former  works  it  would  seem  that  he  had 
exhausted  the  subject  of  Physiology.  In  the  present, 
he  gives  the  essence,  as  it  were,  of  the  whole. — N.  Y. 
Journal  of  Medicine. 

Those  who  have  occasion  for  an  elementary  trea- 
tise on  Physiology,  cannot  do  better  than  to  possess 
themselves  of  the  manual  of  Dr.  Carpenter. — Medical 
Examiner. 


The  best  and  most  complete  expos6  of  modern 
Physiology,  in  one  volume,  extant  in  the  English 
language. — St.  Louis  Medical  Journal. 

With  such  an  aid  in  his  hand,  there  is  no  excuse 
for  the  ignorance  often  displayed  respecting  the  sub- 
jects of  which  it  treats.  From  its  unpretending  di- 
mensions, it  may  not  be  so  esteemed  by  those  anxious 
to  make  a  parade  of  their  eruditicm ;  but  whoever 
masters  its  contents  will  have  reason  to  be  proud  of 
his  physiological  acquirements.  The  illustrations 
are  well  selected  and  finely  executed.— Dwdim  Med. 
Press. 


BY   THE   SAME   AUTHOR. 

A  PRIZE  ESSAY  ON  THE  USE  OF  ALCOHOLIC  LIQUORS  IN  HEALTH 

AND  DISEASE.     New  edition,  with  a  Preface  by  D.  F.  Condie,  M.  D.,  and  explanations  of 
scientific  words.    In  one  neat  12mo.  rolume.     {Now  Ready.) 

This  new  edition  has  been  prepared  with  a  view  to  an  extended  circulation  of  this  important  little 
work,  which  is  xmiversally  recognized  as  the  best  exponent  of  the  laws  of  physiology  and  pathology 
applied  to  the  subject  of  intoxicating  liquors,  in  a  form  suited  both  for  the  profession  and  the  public. 
To  secure  a  wider  dissemination  of  its  doctrines  the  publishers  have  done  up  copies  in  fiexible 
cloth,  suitable  for  mailing,  which  will  be  forwarded  through  the  post-office,  free,  on  receipt  of  fifty 
cents.    Societies  and  others  supplied  in  quantities  for  distribution  at  a  liberal  deduction. 


CHELIUS   (J.  M.),    M.  D., 

Professor  of  Surgery  in  the  University  of  Heidelberg,  &c. 

A  SYSTEM  OF  SURGERY.  Translated  from  the  German,  and  accompanied 
with  additional  Notes  and  References,  by  John  F.  South.  Complete  in  three  very  large  octavo 
volumes,  of  nearly  2200  pages,  strongly  bound,  with  raised  bands  and  double  titles. 


We  do  not  hesitate  to  pronounce  it  the  best  and 
most  comprehensive  system  of  modern  surgery  with 
which  we  are  acquainted. — Medico- C hirurgical  Re- 
view. 

The  fullest  and  ablest  digest  extant  of  all  that  re- 
lates to  the  present  advanced  state  of  surgical  pa- 
thology.— American  Medical  Journal. 

As  complete  as  any  system  of  Surgery  can  well 
be. — Southern  Medical  and  SurgicalJournal. 


The  most  learned  and  complete  systematic  treatise 
now  extant. — Edinburgh  Medical  Journal. 

A  complete  encyclopaedia  of  surgical  science — a 
very  complete  surgical  library — by  far  the  most 
complete  and  scientific  system  of  surgery  in  the 
English  language. — N.  Y.  Journal  of  Medicine. 

The  most  extensive  and  comprehensive  account  of 
the  art  and  science  of  Surgery  in  our  language. — 
Lancet. 


CHRISTISON  (ROBERT),  M.  D.,  V.  P.  R.  S.  E.,  &c. 
A  DISPENSATORY;  or,  Commentary  on  the  Pharmacopoeias  of  Great  Britain 

and  the  United  States ;  comprising  the  Natural  History,  Description,  Chemistry,  Pharmacy,  Ac- 
tions, Uses,  and  Doses  of  the  Articles  of  the  Materia  Medica.  Second  edition,  revised  and  im- 
proved, with  a  Supplement  containing  the  most  important  New  Remedies.  With  copious  Addi- 
tions, and  two  hundred  and  thirteen  large  wood-engravings.  By  R.  Eglesfeld  Griffith,  M.  D. 
In  one  very  large  and  handsome  octavo  volume,  of  over  1000  pages. 


It  is  not  needful  that  we  should  compare  it  with 
the  other  pharmacopoeias  extant,  which  enjoy  and 
merit  the  confidence  of  the  profession  :  it  is  enough 
to  say  that  it  appears  to  us  as  perfect  as  a  Dispensa- 
tory, in  the  present  state  of  pharmaceutical  science, 
could  be  made.  If  it  omits  any  details  pertaining  to 
this  branch  of  knowledge  which  the  student  has  a 
right  to  expect  in  such  a  work,  we  confess  the  omis- 
sion has  escaped  our  scrutiny.  We  cordially  recom- 
mend this  work  to  such  of  our  readers  as  are  in  need 
of  a  Dispensatory.  They  cannot  make  choice  of  a 
better. — Western  Journ.  of  Medicine  and  Surgery. 


There  is  not  in  any  language  a  more  complete  and 
perfect  Treatise. — N.  Y.  Annalist. 

In  conclusion,  we  need  scarcely  say  that  we 
strongly  recommend  this  work  to  all  classes  of  our 
readers.  As  a  Dispensatory  and  commentary  on  the 
Pharmacopoeias,  it  is  unrivalled  in  the  English  or 
any  other  language. — The  Dublin  Quarterly  Journal . 

We  earnestly  recommend  Dr.  Christison's  Dis- 
pensatory to  all  our  readers,  as  an  indispensable 
companion,  not  in  the  Study  only,  but  in  the  Surgejy 
also. — British  and  Foreign  Medical  Review. 


BLANCHARD  &  LEA»9  MEDICAL 


CONDIE  (D.  F.),  M.  D.,  &c. 
A  PKACTICAL  TREATISE  ON  THE  DISEASES  OE  CHILDREN.    Fourth 

edition,  revised  and  augmented.  In  one  large  volume,  8vo.,  of  nearly  750  pages.  {Just  Issued.) 
From  the  Author's  Preface. 

The  demand  for  another  edition  has  afforded  the  author  an  opportunity  of  again  subjecting  the 
entire  treatise  to  a  careful  revision,  and  of  incorporating  in  it  every  important  observation  recorded 
since  the  appearance  of  the  last  edition,  in  reference  to  the  pathology  and  therapeutics  of  the  several 
diseases  of  which  it  treats. 

In  the  preparation  of  the  present  edition,  as  in  those  which  have  preceded,  while  the  author  has 
appropriated  to  his  use  every  important  fact  that  be  has  found  recorded  in  the  works  of  others, 
having  a  direct  bearing  upon  either  of  the  subjects  of  which  he  treats,  and  the  numerous  valuable 
observations — pathological  as  well  as  practical — dispersed  throughout  the  pages  of  the  medical 
journals  of  Europe  and  America,  he  has,  nevertheless,  relied  chiefly  upon  his  own  observations  and 
experience,  acquired  during  a  long  and  somewhat  extensive  practice,  and  under  circumstances  pe- 
culiarly well  adapted  for  the  clinical  study  of  the  diseases  of  early  life. 

Every  species  of  hypothetical  reasoning  has,  as  much  as  possible,  been  avoided.  The  author  has 
endeavored  throughout  the  work  to  confine  himself  to  a  simple  statement  of  well-ascertained  patho- 
logical facts,  and  plain  therapeutical  directions — his  chief  desire  being  to  render  it  what  its  title 
imports  it  to  be,  a  practical  treatise  on  the  diseases  of  children. 


Dr.  Condie-s  scholarship,  aciimenj  industry,  and 
practical  sense  are  manifested  in  this,  as  in  all  his 
numerous  contributions  to  science. — Dr.  Holmes's 
Report  to  the  American  Medical  Association, 

Taken  as  a  whole,  in  our  judgment.  Dr.  Condie's 
Treatise  is  the  one  from  the  perusal  of  which  the 
practitioner  in  this  country  will  rise  with  the  great- 
est satisfaction  — Western  Journal  of  Medicine  and 
Surgery. 

One  of  the  best  works  upon  the  Diseases  of  Chil- 
dren in  the  English  language. — Western  Lancet. 

Perhaps  the  most  full  and  complete  work  now  be- 
fore the  profession  of  the  United  States ;  indeed,  we 
may  say  in  the  English  language.  It  is  vastly  supe- 
rior to  most  of  its  predecessors. — Transylvania  Med. 
Journal. 


We  feel  assured  from  actual  experience  that  no 
physician's  library  can  be  complete  without  a  copy 
of  this  work. — N.  Y.  Journal  of  Medicine. 

A  veritable  peediatric  encyclopeedia,  and  an  honor 
to  American  medical  literature. — Ohio  Medical  and 
Surgical  Journal. 

We  feel  persuaded  that  the  American  medical  pro- 
fession will  soon  regard  it  not  only  as  a  very  good, 
but  as  the  very  best  "Practical  Treatise  on  the 
Diseases  of  Children." — American  Medical  Journal. 

We  pronounced  the  first  edition  to  be  the  best 
work  on  the  diseases  of  children  in  the  English 
language,  and,  notwithstanding  all  that  has  been 
published,  we  still  regard  it  in  that  light. — Medical 
Examiner. 


COOPER  (BRANSBY  B.),  F.  R.  S., 

Senior  Surgeon  to  Guy's  Hospital,  &c. 

LECTURES  ON  THE   PRINCIPLES   AND   PRACTICE  OF   SURGERY. 

In  one  very  large  octavo  volume,  of  750  pages.    {Lately  Issued.) 


For  twenty- five  years  Mr.  Bransby  Cooper  has 
been  surgeon  to  Guy's  Hospital;  and  the  volume 
before  us  may  be  said  to  consist  of  an  account  of 
th^  results  of  his  surgical  experience  during  that 
long  period.   We  cordially  recommend  Mr.  Bransby 


Cooper's  Lectures  as  a  most  valuable  addition  to 
our  surgical  literature,  and  one  which  cannot  fail 
to  be  of  service  both  to  students  and  to  those  who 
are  actively  engaged  in  the  practice  of  their  profea- 
sion. — The  Lancet. 


COOPER  (SIR  ASTLEY   P.),   F.  R.  S.,  <Stc. 
A  TREATISE  ON  DISLOCATIONS  AND  FRACTURES  OF  THE  JOINTS. 

Edited  by  Bransby  B.  Cooper,  F.  R.  S.,  &c.  With  additional  Observations  by  Prof.  J.  C, 
Warren.  A  new  American  edition.  In  one  handsome  octavo  volume,  with  numerous  illustra- 
tions on  wood. 

BY   THE   SAME   AUTHOR. 

ON  THE  ANATOMY  AND  TREATMENT  OF  ABDOMINAL  HERNIA. 

One  large  volume,  imperial  8vo.,  with  over  130  lithographic  iigures. 

BY   THE   SAME   AUTHOR. 

ON  THE   STRUCTURE   AND   DISEASES   OF  THE  TESTIS,  AND  ON 

THE  THYMUS  GLAND.     One  vol.  imperial  8vo.,  with  177  figures,  on  29  plates. 


BY   THE   SAME   AUTHOH. 

ON  THE  ANATOMY  AND  DISEASES  OF  THE  BREAST,  with  twenty- 
five  Miscellaneous  and  Surgical  Papers.    One  large  volume,  imperial  8vo.,  with  252  figures,  oa 
36  plates. 
These  last  three  volumes  complete  the  surgical  writings  of  Sir  Astley  Cooper.    They  are  very 

handsomely  printed,  with  a  large  number  oi  lithographic  plates,  executed  in  the  best  style,  and  arc 

pr«8ented  at  exceedingly  law  price*. 


AND   SCIENTIFIC    PUBLICATIONS. 


CHURCHILL  (FLEETWOOD),  M.  D.,  M.  R.  I.  A'/' ^ 
ON  THE  THEORY  AND  PRACTICE  OF  MIDWIFERY.  A  new  American, 

from  the  last  and  improved  English  edition.  Edited,  with  Notes  and  Additions,  by  D.  Fkancis 
CoNDiE,  M.  D.,  author  of  a  "Practical  Treatise  on  the  Diseases  of  Children,"  &;o.  With  139 
illustrations.    In  one  very  handsome  octavo  volume,  pp.  510.     (Lately  Issued.) 

No  work  holds  a  higher  position,  or  is  more  de- 
serving of  being  placed  in  the  hands  of  the  tyro, 
the  advanced  student,  or  the  practitioner. — MedicM 
Exami-ner. 


To  bestov/  praise  on  a  book  that  has  received  such 
Marked  approbation  would  be  superfluous.  We  need 
only  say,  therefore,  that  if  the  first  edition  was 
thought  worthy  of  a  favorable  reception  by  the 
aiedical  public,  we  can  confidently  affirm  that  this 
will  be  found  much  more  so.  The  lecturer,  the 
practitioner,  and  the  student,  may  all  have  recourse 
fco  its  pages,  and  derive  from  their  perusal  much  in- 
terest and  instruction  in  everything  relating  to  theo- 
retical and  practical  midwifery,— Du6itn  Quarterly 
Journal  of  Medical  Science. 

A  work  of  very  great  merit,  and  such  as  we  can 
confidently  recommend  to  the  study  of  every  obste- 
tric practitioner. — London  Medical  Gazette. 

This  is  certainly  the  most  perfect  system  extant, 
ft  is  the  best  adapted  for  the  purposes  of  a  text- 
b(X)k,  and  that  which  he  whose  necessities  confine 
him  to  one  book,  should  select  in  preference  to  ail 
others. — Southern  Medical  and  Surgical  Journal. 

The  most  popular  work  on  midwifery  ever  issued 
from  the  American  press. — Charleston  Med.  Journal. 

Were  we  reduced  to  the  necessity  of  having  but 
tme  v/ork  on  midwifery,  and  permitted  to  choose, 
we  would  unhesitatingly  take  Churchill. — Western 
Med.  and  Surg.  Journal. 

It  is  impossible  to  conceive  a  more  useful  and 
elegant  manual  than  Dr.  Churchill's  Practice  of 
Midwifery. — Provincial  Medical  Journal. 

Certainly,  in  our  opinion,  the  very  best  work  on 
ike  subject  which  exists. — N.  Y.  Annalist. 


Previous  editions,  under  the  editorial  supervision 
of  Prof  R.  M.  Huston,  have  been  received  with 
marked  favor,  and  they  deserved  it;  but  this,  re- 
printed from  a  very  late  Dublin  edition,  carefully 
revised  and  brought  up  by  the  author  to  the  present 
time,  does  present  an  unusually  accurate  and  able 
exposition  of  every  important  particular  embraced 
in  the  department  of  midwifery.  *=  *=  The  clearness, 
directnesG,  and  precision  of  its  teachings,  together 
with  the  great  amount  of  statistical  research  which 
its  text  exhibits,  have  served  to  place  it  already  in 
the  foremost  rank  of  works  in  this  department  of  re- 
medial science. — N.  O.  Med.  and  Surg.  Journal. 

In  our  opinion,  it  forms  one  of  the  best  if  not  the 
very  best  text-book  and  epitome  of  obstetric  science 
which  we  at  present  possess  in  the  English  Vda- 
gxtai^e.— Monthly  Journal  of  Medical  Science. 

The  clearness  and  precision  of  style  in  which  it  is 
written,  and  the  great  amount  of  statistical  research 
which  it  contains,  have  served  to  place  it  in  the  first 
rank  of  works  in  this  department  of  medical  science. 
—N.  Y.  Journal  of  Medicine. 

Few  treatises  will  be  found  better  adapted  as  a 
text-book  for  the  student,  or  as  a  manual  for  the 
frequent  consultation  of  the  young  practitioner, — 
American  Medical  Journal. 


BY   THE   SAME   AUTHOR. 


ON  THE  DISEASES  OF  INFANTS  AND  CHILDREN.     In  one  large  and 

handsome  volume  of  over  600  pages. 

The  present  volume  will  sustain  the  reputaCioa 
acquired  by  the  author  from  his  previous  works. 
The  reader  will  find  in  it  full  and  judicious  direc- 
tions for  the  management  of  infants  at  birth,  and  a 
compendious,  but  clear  account  of  the  diseases  to 
which  children  are  liable,  and  the  most  successful 
mode  of  treating  them.  We  must  not  close  this  no- 
tice without  calling  attention  to  the  author's  style, 
which  is  perspicuous  and  polished  to  a  degree,  we 
regret  to  say,  not  generally  characteristic  of  medical 
works.  We  recommend  the  work  of  Dr,  Churchill 
most  cordially,  both  to  students  and  practitioners, 
as  a  valuable  and  reliable  guide  in  the  treatment  of 
the  diseases  of  children. — Am.  Journ.  of  the  Med. 
Sciences. 


We  regard  this  volume  as  possessing  more  claims 
fco  completeness  than  any  other  of  the  kind  with 
which  we  are  acquainted.  Most  cordially  and  earn- 
estly, therefore,  do  we  commend  it  to  our  profession- 
al brethren,  and  we  feel  assured  that  the  stamp  of 
their  approbation  will  indue  time  be  impressed  upon 
it.  After  an  attentive  perusal  of  its  contents,  we 
hesitate  not  to  say,  that  it  is  one  of  the  most  com- 
prehensive ever  written  upon  the  diseases  of  chil- 
dren, and  that,  forcopiousnessof  reference,  extent  of 
research,  and  perspicuity  of  detail,  it  is  scarcely  to 
be  ©quailed,  and  not  to  be  excelled,  in  any  lan- 
guage.— Dublin  Quarterly  Journal. 

After  this  meagre,  and  we  know,  very  imperfect 
notice  of  Dr.  Churchill's  work,  we  shall  conclude 
by  saying,  that  it  is  one  that  cannot  fail  from  its  co- 
piousness, extensive  research,  and  general  accuracy, 
to  exalt  still  higher  the  reputation  of  the  author  in 
this  country.  The  American  reader  will  be  particu- 
larly pleased  to  find  that  Dr.  Churchill  has  done  full 
justice  throughout  his  work  to  the  various  A  merican 
authors  on  this  subject.  The  names  of  Dewees, 
Eberle,  Condie,  and  Stewart,  occur  on  nearly  every 
page,  and  these  authors  are  constantly  referred  to  by 
the  author  in  terms  of  the  highest  praise,  and  with 
the  most  liberal  courtesy. — The  Medical  Examiner. 


We  know  of  no  work  on  this  department  of  Prac- 
tical Medicine  which  presents  so  candid  and  unpre- 
judiced a  statement  or  posting  up  of  our  actual 
knowledge  as  this. — N.  Y.  Journal  of  Medicine. 

Its  claims  to  merit  both  as  a  scientific  and  practi- 
cal %vork,  are  of  the  highest  order.  Whilst  we 
would  not  elevate  it  above  every  other  treatise  on 
the  same  subject,  we  certainly  believe  that  very  few 
are  equal  to  it,  and  none  superior. — Southern  Med. 
and  Surgical  Journal. 


BY  THE  SAME  AUTHOR. 


ESSAYS  ON  THE  PUERPERAL  FEVER,  AND  OTHER  DISEASES  PE- 
CULIAR TO  WOMEN.  Selected  from  the  writings  of  British  Authors  previous  to  the  close  of 
the  Eighteenth  Century.    In  one  neat  octavo  volume,  of  about  four  hundred  and  fifty  pages. 


To  these  papers  Dr.  Churchill  has  appended  notes, 
embodying  whatever  information  has  been  laid  be- 
fore the  profession  since  their  authors'  time.  He  has 
also  prefixed  to  the  Essays  on  Puerperal  Fever, 
which  occupy  the  larger  portion  of  the  volume,  an 
interesting  historical  sketch  of  the  principal  epi- 


demics of  that  disease.  The  whole  forms  a  very 
valuable  collection  of  papers,  by  professional  writers 
of  eminence,  on  some  of  the  most  important  accidents 
to  which  the  puerperal  female  is  liable. — Ainerietm 
Journal  of  Medical  Sciences. 


10 


BLANCHARD    &   LEA'S   MEDICAL 


CHURCHILL  (FLEETWOOD),    M.  D.,  M.  R.  I.  A.,    &,c. 

ON  THE  DISEASES  OF  WOMEN;  including  those  of  Pregnancy  and  Child- 
bed. A  new  American  edition,  revised  by  the  Author.  With  Notes  and  Additions,  by  D  Fran- 
cis CoNDiE,  M.  D.,  author  of  "A  Practical  Treatise  on  the  Diseases  of  Children."  In  one  large 
and  handsome  octavo  volume,  with  wood-cuts,  pp.  684.     (Just  Issued.) 

From  the  Author'' s  Preface. 
In  reviewing  this  edition,  at  the  request  of  my  American  publishers,  I  have  inserted  several  new 
sections  and  chapters,  and  I  have  added,  I  believe,  all  the  information  we  have  derived  from  recent 
researches ;  in  addition  to  which  the  publishers  have  been  fortunate  enough  to  secure  the  services' 
of  an  able  and  highly  esteemed  editor  in  Dr.  Condie. 


We  now  regretfully  take  leave  of  Dr.  Churchill's 
book.  Had  our  typbgraphical  limits  permitted,  we 
should  gladly  have  borrowed  more  from  its  richly 
stored  pages.  In  conclusion,  we  heartily  recom- 
mend it  to  the  profession,  and  would  at  the  same 
time  express  our  firm  conviction  that  it  will  not  only 
add  to  the  reputation  of  its  author,  hut  will  prove  a 
work  of  great  and  extensive  utility  to  obstetric 
practitioners.— Dwiiin  Medical  Press. 

Former  editions  of  this'work  have  been  noticed  in 
previous  numbers  of  the  Journal.  The  sentiments  of 
high  commendaticm  expressed  in  those  notices,  have 
only  to  be  repeated  in  this;  not  from  the  fact  that 
the  profession  at  large  are  not  aware  of  the  high 
merits  which  this  work  really  possesses,  but  from  a 
desire  to  see  the  principles  and  doctrines  therein 
contained  more  generally  recognized,  and  more  uni- 
versally carried  out  in  practice. — JV.  Y.  Journal  of 
Medicine. 

We  know  of  no  author  who  deserves  that  appro- 
bation, on  "  the  diseases  of  females,"  to  the  same 
extent  that  Dr.  Churchill  does.  His,  indeed,  is  the 
only  thorough  treatise  we  know  of  on  the  subject; 
and  it  may  be  commended  to  practitioners  and  stu- 
dents as  a  masterpiece  in  its  particular  department. 
The  former  editions  of  this  work  have  been  com- 
mended strongly  in  this  journal,  and  they  have  won 
their  way  to  an  extended,  and  a  well-deserved  popu- 


larity. This  fifth  edition,  before  us.  is  well  calcu- 
lated to  maintain  Dr.  Churchill's  high  reputation. 
It  was  revised  and  enlarged  by  the  author,  for  his 
American  publishers,  and  it  seems  to  us  that  there  is 
scarcely  any  species  of  desirable  information  on  its 
subjects  that  may  not  be  found  in  this  work. — Ths 
Western  Journal  of  Medicine  and  Surgery. 

We  are  gratified  to  announce  a  new  and  revised 
edition  of  Dr.  Churchill's  valuable  work  on  the  dis- 
eases of  females  We  have  ever  regarded  it  as  one 
of  the  yery  best  works  on  the  subjects  embraced 
within  its  scope,  in  the  English  language;  and  the 
present  edition,  enlarged  and  revised  by  the  author, 
renders  it  still  more  entitled  to  the  confidence  of  the 
profession.  The  valuable  notes  of  Prof.  Huston 
have  been  retained,  and  contribute,  in  no  small  de- 
gree, to  enhance  the  value  of  the  work.  It  is  a 
source  of  congratulaticm  that  the  publishers  have 
permitted  the  author  to  be,  in  this  instance,  his 
own  editor,  thus  securing  all  the  revision  which 
an  author  alone  is  capable  of  making. — The  Western 
Lancet. 

As  a  comprehensive  manual  for  students,  or  a 
work  of  reference  for  practitioners,  we  only  speak 
with  common  justice  when  we  say  that  it  surpasses 
any  other  that  has  ever  issued  on  the  same  sub- 
ject from  the  British  press. — The  Dublin  Quarterly 
Journal. 


DEWEES   (W.    P.),   M.D.,    &.c, 
A   COMPKEHENSIVE   SYSTEM  OF   MIDWIFERY.     Elustrated  by  occa- 

sional  Cases  and  many  Engravings.     Twelfth  edition,  with  the  Author's  last  Improvements  and 
Corrections.     In  one  octavo  volume,  of  600  pages.     {Jfust  Issued.) 


BY   THE   SAME    AUTHOR. 


A  TREATISE  ON  THE  PHYSICAL  AND  MEDICAL  TREATMENT  OF 

CHILDREN.     Tenth  edition.     In  one  volume,  octavo,  548  pages.     {Just  Iss^ied.) 


BY   THE    SAME   AUTHOR. 

A  TREATISE  ON   THE   DISEASES   OF   FEMALES.     Tenth   edition. 

one  volume,  octavo,  532  pages,  with  plates.     {Just  Issued.) 


In 


DICKSON    (PROFESSOR    S.    H.),    M.D. 

ESSAYS  ON  LIFE,  SLEEP,  PAIN,  INTELLECTION,  HYGIENE,  AND 

DEATH.     In  one  very  handsome  volume,  royal  12mo. 


DANA    (JAMES    D). 

ZOOPHYTES  AND  CORALS.     In  one  volume,  imperial  quarto,  extra  clotli, 
with  wood-cuts. 

ALSO, 

AN  ATLAS  TO  THE  ABOVE,  one  volume,  imperial  folio,  with  sixtj-one  mag- 
nificent plates,  colored  after  nature.    Bound  in  half  morocco. 

ALSO, 

ON    THE    STRUCTURE    AND    CLASSIFICATION    OF    ZOOPHYTES. 

Sold  separate,  one  vol.,  cloth. 


DE    LA    BECHE   (SIR    HENRY    T.),   F.  R.  S.,  &c. 

THE  GEOLOGICAL  OBSERVER.     In  one  very  large  and  handsome  octavo 
volume,  of  700  pages.    "With  over  three  hundred  wood-cubs.     {Lately  Issued.) 


AND   SCIENTIFIC    PUBLICATIONS. 


11 


DRUITT  (ROBERT),   M.R.  C.S.,   &c. 
THE  PRINCIPLES  AND  PRACTICE   OF  MODERN   SURGERY.     A  new 

American,  from  the  improved  London  edition.  Edited  by  P.  W.  Sargent,  M.  D.,  author  of 
"Minor  Surger}/^,"  &c.  Illustrated  with  one  hundred  and' ninety-three  wood-eng-ravings.  In 
one  very  handsomely  printed  octavo  volume,  of  576  large  pages. 


Dr.  Druitt'a  researches  into  the  literature  of  his 
subject  have  been  not  only  extensive,  but  well  di- 
rected ;  the  most  discordant  authors  are  fairly  and 
impartially  quoted,  and,  while  due  credit  is  given 
to  each,  their  respective  merits  are  weighed  with 
an  unprejudiced  hand.  The  grain  of  wheat  is  pre- 
served, and  the  chaff  is  unmercifully  stripped  off. 
The  arrangement  is  simple  and  philosophical,  and 
the  style,  though  clear  and  interesting,  is  so  precise, 
that  the  book  contains  more  information  condensed 
into  a  few  words  than  any  other  surgical  work  with 
which  we  are  acquainted. — London  Medical  Times 
and  Gazette,  February  18,  1854. 

No  work,  in  our  opinion,  equals  it  in  presenting 
so  much  valuable  surgical  matter  in  so  small  a 
compass. — St.  Louis  Med.  and  Surgical  Journal. 

Druitt's  Surgery  is  too  well  known  to  the  Ameri- 
can medical  profession  to  require  its  announcement 
anywhere.  Probably  no  work  of  the  kind  has  ever 
been  more  cordially  received  and  extensively  circu- 
lated than  this.  The  fact  that  it  comprehends  in  a 
comparatively  small  compass,  all  the  essential  ele- 
ments of  theoretical  and  practical  Surgery — that  it 
is  found  to  contain  reliable  and  authentic  informa- 
tion on  the  nature  and  treatment  of  nearly  all  surgi- 
cal affections — is  a  sufficient  reason  for  the  liberal 
patronage  it  has  obtained.  The  editor,  Dr.  F.  W. 
Sargent,  has  contributed  much  to  enhance  the  value 
of  the  w^ork,  by  such  American  improvements  as  are 
calculated  more  perfectly  to  adapt  it  to  our  own 
views  and  practice  in  this  country.  It  abounds 
everywhere  with  spirited  and  life-like  illustrations, 
which  to  the  young  surgeon,  especially,  are  of  no 
minor  consideration.  Every  medical  man  frequently 
needs  just  such  a  work  as  this,  for  immediate  refe- 
rence in  moments  of  sudden  emergency,  when  he  has 
not  time  to  consult  more  elaborate  treatises. — The 
Ohio  Medical  and  Surgical  Journal. 

The  author  has  evidently  ransacked  every  stand- 
ard treatise  of  ancient  and  modern  times,  and  all  that 


is  really  practically  useful  at  the  bedside  will  be 
found  in  a  form  at  once  clear,  distinct,  and  interest- 
ing.— Edinburgh  Monthly  Medical  Journal. 

Druitt's  work,  condensed,  systematic,  lucid,  and 
practical  as  it  is,  beyond  most  works  on  Surgery 
accessible  to  the  American  student,  has  had  much 
currency  in  this  country,  and  under  its  present  au- 
spices promises  to  rise  to  yet  higher  favor. — The 
Western  Journal  of  Medicine  and  Surgery. 

The  most  accurate  and  ample  resum6  of  the  pre- 
sent state  of  Surgery  that  we  are  acquainted  with.— 
Dublin  Medical  Journal," 

A  better  book  on  the  principles  and  practice  of 
Surgery  as  now  understood  in  England  and  America, 
has  not  been  given  to  the  profession.— JSos^on  Medi- 
cal and  Surgical  Journal. 

An  unsurpassable  compendium,  not  only  of  Sur- 
gical, but  of  Medical  Practice. — London  Medical 
Gazette. 

This  work  merits  our  warmest  commendations, 
and  we  strongly  recommend  it  to  young  surgeons  as 
an  admirable  digest  of  tlie  principles  and  practice  of 
modern  Surgery. — Medical  Gazette. 

It  maybe  said  with  truth  that  the  work  of  Mr. 
Druitt  affords  a  complete,  though  brief  and  con- 
densed view,  of  the  entire  field  of  modern  surgery. 
We  know  of  no  work  on  the  same  subject  having  the 
appearance  of  a  manual,  which  includes  so  many 
topics  of  interest  to  the  surgeon  ;  and  the  terse  man- 
ner in  which  each  has  been  treated  evinces  a  most 
enviable  quality  of  mind  on  the  part  of  the  author, 
who  seems  to  have  an  innate  power  of  searching 
out  and  grasping  the  leading  facts  and  features  of 
the  most  elaborate  productions  of  the  pen.  It  is  a 
useful  handbook  for  the  practitioner,  and  we  should 
deem  a  teacher  of  surgery  unpardonable  who  did  not 
recommend  it  to  his  pupils.  In  our  own  opinion,  it 
is  admirably  adapted  to  the  wants  of  the  student. — 
Provincial  Medical  and  Surgical  Journal. 


DUNGLISON,    FORBES,   TWEEDIE,    AND   CONOLLY. 

THE  CYCLOPiEDIA  OF  PRACTICAL  MEDICINE:  comprising  Treatises  on 
the  Nature  and  Treatment  of  Diseases,  Materia  Medica,  and  Therapeutics,  Diseases  of  Women 
and  Children,  Medical  Jurisprudence,  &c.  &c.  In  four  large  super  royal  octavo  volumes,  of 
3254  double-columned  pages,  strongly  and  handsomely  bound. 

*^*  This  work  contains  no  less  than  four  hundred  and  eighteen  distinct  treatises,  contributed  by 
SL3».y-eight  distinguished  physicians. 


The  most  complete  work  on  Practical  Medicine 
extant;  "or,  at  least,  in  our  language.— .Bu/^aZo 
Medical  and  Surgical  Journal. 

For  reference,  it  is  above  all  price  to  every  prac- 
titioner.—Western  Lancet. 

One  of  the  most  valuable  medical  publications  of 
the  day — as  a  work  of  reference  it  is  invaluable. — 
Western  Journal  of  Medicine  and  Surgery. 

It  has  been  to  us,  both  as  learner  and  teacher,  a 
work  for  ready  and  frequent  reference,  one  in  which 
modern  English  medicine  is  exhibited  in  the  most 
advantageous  light.— JVIed/ca/  Examiner. 

We  rejoice  that  this  work  is  to  be  placed  within 
the  reach  of  the  profession  in  this  country,  it  being 


unquestionably  one  of  very  great  value  to  the  prac- 
titioner. This  estimate  of  it  has  not  been  formed 
from  a  hasty  examination,  but  after  an  intimate  ac- 
quaintance derived  from  frequent  consultation  of  it 
during  the  past  nine  or  ten  years.  The  editors  are 
practitioners  of  established  reputation,  and  the  list 
of  contributors  embraces  many  of  the  most  eminent 
professors  and  teachers  of  London,  Edinburgh,  Dub- 
lin, and  Glasgow.  It  is,  indeed,  the  great  merit  of 
this  work  that  the  principal  articles  have  been  fur- 
nished by  practitioners  who  have  not  only  devoted 
especial  attention  to  the  diseases  about  which  they 
have  written,  but  have  also  enjoyed  opportunities 
for  an  extensive  practical  acquaintance  with  them, 
and  whose  reputation  carries  the  assurance  of  their 
competency  justly  to  appreciate  the  opinions  of 
others,  while  it  stomps  their  own  doctrines  with 
high  and  just  authority. — American  Medical  Joum. 


DUNGLISON    (ROBLEY),    M.  D., 

Professor  of  the  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

HUMAN  HEALTH;  or,  the  Influence  of  Atmosphere  and  Locality,  Change  of 
Air  and  Climate,  Seasons,  Food,  Clothing,  Bathing,  Exercise,  Sleep,  (tec.  &c.,  on  Healthy  Man; 
constituting  Elements  of  Hygiene.  Second  edition,  with  many  modifications  and  additions.  In 
one  octavo  volume,  of  464  pages. 


12 


BLANCHARD   &   LEA'S   MEDICAL 


DUNGLISON    (ROBLEY),    M.  D., 

Professor  of  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

MEDICAL  LEXICON;  a  Dictionary  of  Medical  Science,  containinsr  a  concise 
Explanation  of  the  various  Subjects  and  Terms  of  Physiology,  Pathology,  Hygiene,  Therapeutics, 
Pharmacology',  Obstetrics,  Medical  Jurisprudence,  &c.  With  the  French  and  other  Synonymes ; 
Notices  of  Climate  and  of  celebrated  Mineral  Waters;  Formute  for  various  Officinal,  Empirical, 
and  Dietetic  Preparations,  etc.  Eleventh  edition,  revised.  In  one  very  thick  octavo  vohune,  ol 
over  nine  hundred  large  double-columned  pages,  strongly  bound  in  leather,  with  raised  bands. 
(Just  Isstied.) 

Every  successive  edition  of  this  work  bears  the  marks  of  the  industry  of  the  author,  and  of  his 
determination  to  keep  it  fully  on  a  level  with  the  most  advanced  state  of  medical  science.  Thus 
nearly  fifteen  thousand  words  have  been  added  to  it  within  the  last  few  years.  As  a  complete 
Medical  Dictionary,  therefore,  embracing  over  FIFTY  THOUSAND  DEFINITIONS,  m  all  the 
branches  of  the  science,  it  is  presented  as  meriting  a  continuance  of  the  great  favor  and  popularity 
which  have  carried  it,  within  no  very  long  space  of  time,  to  an  eleventh  edition. 

Every  precaution  has  been  taken  in  the  preparation  of  the  present  volume,  to  render  its  mecha- 
nical execution  and  typographical  accuracy  worthy  of  its  extended  reputation  and  universal  use. 
The  very  extensive  additions  have  been  accommodated,  without  materially  increasing  the  bulk  oi 
the  volume  by  the  employment  of  a  small  but  exceedingly  clear  type,  cast  for  this  purpose.  The 
press  has  been  watched  with  great  care,  and  every  effort  used  to  insure  the  verbal  accuracy  so  ne- 
cessary to  a  work  of  this  nature.  The  whole  is  printed  on  fine  white  pap-er ;  and,  while  thus  exhi- 
biting in  every  respect  so  great  an  improvement  over  former  issues,  it  is  presented  at  the  original 
exceedingly  low  price. 


We  welcome  it  cordially ;  it  is  an  admirable  work, 
and  indispensable  to  all  literary  medical  men.  The 
labor  which  has  been  bestowed  upon  it  is  something 
prodigious.  The  work,  however,  has  now  been 
done,  and  we  are  happy  in  the  thought  that  no  hu- 
man being  will  have  again  to  undertake  the  same 
gigantic  task.  Revised  and  corrected  from  time  to 
time,  Dr.  Dunglison's  "  Medical  Lexicon"  will  last 
for  centuries. — British  and  Foreign  Med.  Chirurg. 
Review,  July,  1853. 

The  fact  that  this  excellent  and  learned  work  has 
passed  through  eight  editions,  and  that  a  ninth  is 
rendered  necessary  by  the  demands  of  the  public, 
affords  a  sufficient  evidence  of  the  general  apprecia- 
tion of  Dr.  Dunglison's  labors  by  the  medical  pro- 
fession in  England  and  America.  It  is  a  book  which 
w^ill  be  of  great  service  to  the  student,  in  teaching 
him  the  meaning  of  all  the  technical  terms  used  in 
medicine,  and  w^ill  be  of  no  less  use  to  the  practi- 
tioner who  desires  to  keep  himself  on  a  level  with 
the  advance  of  medical  science. — London  Medical 
Times  and  Gazette. 

In  taking  leave  of  our  author,  we  feel  compelled 
to  confess  that  his  work  bears  evidence  of  almost 
incredible  labor  having  been  bestowed  upon  its  com- 
position.—  Edinburgh  Journal  of  Med.  Sciences, 
Sept. 1853. 

A  miracle  of  labor  and  industry  in  one  who  has 
written  able  and  voluminous  works  on  nearly  every 
branch  of  medical  science.  There  could  be  no  more 
useful  book  to  the  student  or  practitioner,  in  the 
present  advancing  age,  than  one  in  which  would  be 
found,  in  addition  to  the  ordinary  meaning  and  deri- 
vation of  medical  terms — so  many  of  which  are  of 
modern  introduction — concise  descriptions  of  their 
explanation  and  employment ;  and  ail  this  and  much 
more  is  contained  in  the  volume  before  us.  It  is 
therefore  almost  as  indispensable  to  the  other  learned 
professions  as  to  our  own.  In  fact,  to  all  who  may 
have  occasion  to  ascertain  the  meaning  of  any  word 
belonging  to  the  many  branches  of  medicine.  From 
a  careful  examination  of  the  present  edition,  we  can 
vouch  for  its  accuracy,  and  for  its  being  brought 
quite  up  to  the  date  of  publication  ;  the  author  states 
ia  his  preface  that  he  has  added  to  it  about  four  thou- 
sand terms,  which  are  not  to  be  found  in  the  prece- 
ding one.  —  Dublin  Quarterly  Journal  of  Medical 
Sciences. 

On  the  appearance  of  the  last  edition  of   this 


valuable  work,  we  directed  the  attention  of  our 
readers  to  its  peculiar  merits ;  and  we  need  do 
little  more  than  state,  in  reference  to  the  present 
reissue,  that,  notwithstanding  the  large  additions 
previously  made  to  it,  no  fewer  than  four  thou- 
sand terms,  not  to  be  found  in  the  preceding  edi- 
tion, are  contained  in  the  volume  before  us. — 
Whilst  it  is  a  wonderful  monument  of  its  author's 
erudition  and  industry,  it  is  also  a  work  of  great 
practical  utility,  as  we  can  testify  from  o»r  owa 
experience;  for  we  keep  it  constantly  within  out 
reach,  and  make  very  frequent  reference  to  it, 
nearly  always  finding  in  it  the  information  Ave  seek. 
— British  and  Foreign  Med.-Chirurg.  Review. 

It  has  the  rare  merit  that  it  certainly  has  no  rivai 
in  the  English  language  for  accuracy  and  extent 
of  references.  The"  terms  generally  include  short 
physiological  and  pathological  descriptions,  so  that, 
as  the  author  justly  observes,  the  reader  does  not 
possess  in  this  work  a  mere  dictionary,  but  a  book, 
which,  while  it  instructs  him  in  medical  etymo- 
logy, furnishes  him  with  a  large  amount  of  useful 
information.  The  author's  labors  have  been  pro- 
perly appreciated  by  his  own  countrymen  ;  and  we 
can  only  confirm  their  judgment,  by  recommending 
this  most  useful  volume  to  the  notice  of  our  cisat- 
lantic readers.  No  medical  library  will  be  complete 
without  it. — London  Med.  Gazette. 

It  is  certainly  mot^  complete  and  comprehensive 
than  any  with  which  we  are  acquainted  in  the 
English  language.  Few,  in  fact,  could  be  found 
better  qualified  than  Dr.  Dunglison  for  the  produc- 
tion of  such  a  work.  Learned,  industrious,  per- 
severing, and  accurate,  he  brings  to  the  task  ail 
the  peculiar  talents  necessary  for  its  successful 
performance;  while,  at  the  same  time,  his  fami- 
liarity with  the  writings  of  the  ancient  and  modera 
"  masters  of  our  art,"  renders  him  skilful  to  note 
the  exact  usage  of  the  several  terms  of  science; 
and  the  various  modifications  which  medical  term- 
inology has  undergone  with  the  change  of  theo- 
ries or  the  progress  of  improvement.  —  American 
Journal  of  the  Medical  Sciences. 

One  of  the  most  complete  and  copious  known  to 
the  cultivators  of  medical  science. — Boston  Med. 
Journal. 

The  most  comprehensive  and  best  English  Dic- 
tionary of  medicaL  terms  extant. — Buffalo  Medical 
Journal. 


BY  THE  SAME  AUTHOR. 


THE  PRACTICE  OF  MEDICINE.     A  Treatise  on  Special  Pathology  and  The- 
rapeutics.   Third  Edition.    In  two  large  octavo  volumes,  of  fifteen  hundred  pages. 


Upon  every  topic  embraced  in  the  work  the  latest 
information  will  be  found  carefully  posted  up. — 
Medical  Examiner. 

The  student  of  medicine  will  find,  in  these  two 
elegant  volumes,  a  mine  of  facts,  a  gathering  of 
precepts  and  advice  from  the  world  of  experience, 
that  will  nerve  him  with  courage,  and  faithfully 
direct  him  in  his  efforts  to  relieve  the  physical  suf- 


ferings of  the  race. 
Journal . 


-Boston  Medical  and  Surgical 


It  is  certainly  the  most  complete  treatise  of  which 
we  haveany  knowledge. — Western  Journal  of  Medi- 
cine and  Surgery. 

One  of  the  most  elaborate  treatises  of  the  kinti 
we  have. — Southern  Med.  and  Surg.  Journal. 


AND   SCIENTIFIC    PUBLICATIONS. 


IS 


DUNGLISON    (ROBLEY),    M.D., 

Professor  of  Institutes  of  Medicine  la  the  Jefferson  Medical  College,  Philadelphia. 

HUMx\N    PHYSIOLOGY.     Seventh   edition.     Thoroughly  revised   and  exten- 

sively  modified  and  enlarged,  with  nearly  five  hundred  illustralions.    In  two  large  and  hand- 
somely printed  octavo  volumes,  containing  nearly  1450  pages. 


It  has  long  since  taken  rank  as  one  of  the  medi- 
eal  classics  of  our  language.  To  say  that  it  is  by 
fur  the  best  text-book  ot  physiology  ever  published 
in  this  country,  is  but  echoing  the  general  testi- 
mony of  the  profession. — N.  Y.  Journal  of  Medicine. 

There  is  no  single  book  we  would  recommend  to 
•he  student  or  physician,  with  greater  confidence 
than  the  present,  because  in  it  will  be  found  a  mir- 
ror of  almost  every  standard  physiological  work  of 
the  day.  We  most  cordially  recommend  the  work 
to  every  member  of  the  profession,  and  no  student 
sfhould  be  without  it.    It  is  the  completest  work  on 


Physiology  in  the  English  language,  and  is  highly 
creditable  to  the  author  and  publishers. — Canadian 
Medical  Journal. 

The  most  complete  and  satisfactory  system  of 
Physiology  in  the  English  language. — Amer.  Med. 
Journal. 

The  best  work  of  the  kind  in  the  English  iau- 
guage. — Silliman's  Journal. 

The  most  full  and  complete  system  of  Pliysiology 
in  our  language. — Western  Lancet. 


BY   THE   SAME    AUTHOR.      {Just  IsSUed.) 

GENEKAL    THERAPEUTICS    AND    MATERIA  MEDIC  A;   adapted  for  a 

Medical  Text-book.  Fifth  edition,  much  improved.  With  one  hundred  and  eighty-sevea  illus- 
trations. In  two  large  and  handsomely  printed  octavo  vols.,  of  about  1100  pages. 
The  new  editions  of  the  United  States  Pharmacopoeia  and  those  of  London  and  Dublin,  have  ren- 
dered necessary  a  thorough  revision  of  this  work.  In  accomplishing  this  the  author  has  spared  no 
pains  in  rendering  it  a  complete  exponent  of  all  that  is  new  and  reliable,  both  in  the  department* 
of  Therapeutic*  and  Materia  Medica.  The  book  has  thus  been  somewhat  enlarged,  and  a  like  im- 
provement will  be  found  in  every  department  of  its  mechanical  execution.  As  a  convenient  text- 
book for  the  student,  therefore,  containing  within  a  moderate  compass  a  satisfactory  resume  of  il« 
important  subject,  it  is  again  presented  as  even  more  worthy  than  heretofore  of  the  very  great  favor 
which  it  has  received. 


In  this  work  of  Dr.  Dunglison,  we  recognize  the 
same  untiring  industry  in  the  collection  and  em- 
bodying of  facts  on  the  several  subjects  of  which  he 
treats,  that  has  heretofore  distinguished  him,  and 
we  cheerfully  point  to  these  volumes,  as  two  of  the 
most  interesting  that  we  know  of.  In  noticing  the 
additions  to  this,  the  fourth  edition,  there  is  very 
little  in  the  periodical  or  annual  literature  of  the 
profession,  published  in  the  interval  which  has 
elapsed  since  the  issue  of  the  first,  that  has  escaped 
the  careful  search  of  the  author.  As  a  book  for 
reference,  it  is  invaluable. —  Charleston  Med.  Jour- 
nal and  Review. 

It  may  be  said  to  be  the  work  now  upon  the  sub- 
iects  upon  which  it  treats. —  Western  Lancet. 


As  a  text-book  for  students,  for  whom  it  is  par- 
ticularly designed,  we  know  of  none  superior  to 
it. — St.  Louis  Medical  and  Surgical  Journal. 

It  purports  to  be  a  new  edition,  but  it  is  rather 
a  new  book,  so  greatly  has  it  been  improved,  both 
in  the  amount  and  quality  of  the  matter  which  it 
contains. — N.  O.  Medical  and  Surgical  Journal. 

We  bespeak  for  this  edition,  from  the  profession, 
an  increase  of  patronage  over  any  of  its  former 
ones,  on  account  of  its  increased  merit.  —  N.  Y. 
Journal  of  Medicine. 


We  consider  this  work  unequalled. 
and  Surg.  Journal. 


■Boston  Med 


BY   THE   SAME   AUTHOR. 

NEW  REMEDIES,  WITH  FORMULA  FOR  THEIR  ADMINISTRATION. 

Sixth  edition,  with  extensive  Additions.     In  one  very  large  octavo  volume,  of  over  750  pages. 

One  of  the  most  useful  of  the  author's  works. —    diseases  and  for  remedies,  will  be  found  greatly  to 
Southern  Medical  and  Surgical  Journal.  enhance  its  value. — New  York  Med.  Gazette. 


This  well-known  and  standard  book  has  now 
Feached  its  sixth  edition,  and  has  been  enlarged  and 
improved  by  the  introduction  of  all  the  recent  gifts 
to  therapeutics  w^hich  the  last  few  years  have  so 
richly  produced,  including  the  anajsthetie  agents, 
&c.  This  elaborate  and  useful  volume  should  be 
found  in  every  medical  library,  for  as  a  book  of  re- 
ference, for  physicians,  it  is  unsurpassed  by  any 
other  work  in  existence,  and  the  double  index  for 


The  great  learning  of  the  author,  and  his  remark- 
able industry  in  pushing  his  researches  into  every 
source  whence  information  is  derivable,  has  enabled 
him  to  throw  together  an  extensive  mass  of  facts 
and  statements,  accompanied  by  full  reference  to 
authorities;  which  lust  feature  renders  the  work 
practically  valuable  to  investigators  who  desire  to 
examine  the  original  papers. — The  American  Journal 
of  Pharmacy. 


DURLACHER   (LEWIS). 
A   TREATISE    ON   CORNS,   BUNIONS,   THE    DISEASES    OF    NAILS, 

AND  THE  GENERAL  MANAGEMENT  OF  THE  FEET.    In  one  12mo.  volume,  cloth. 
pp.  134. 


DE  JONGH  (L.  J.),  M.  D.,  Sec. 
THE  THREE  KINDS   OF  COD-LIVER  OIL,  comparatively  considered,  with 

their  Chemical  and  Therapeutic  Properties.  Translated,  with  an  Ap^iendix  and  Cases,  by 
Edward  Carey,  M.  D.  To  which  is  added  an  article  on  the  subject  from  "Dunglisou  on  New 
Remedies."    In  one  small  12mo.  volume,  extra  cloth. 


DAY  (GEORGE  E.),  M.  D. 
A  PRACTICAL  TREATISE  ON  THE  DOMESTIC  MANAGEMENT  AND 

With  an  Appendix  on  a  new 


MORE  IMPORTANT  DISEASES  OF  ADVANCED   LIFE. 

and  successful  mode  of  treating  Lumbago  and  other  forms  of  Chronic  Rheumatism. 

octavo,  226  pages. 


One  volume 


14 


BLANCHARD   &   LEA'S   MEDICAL 


ELLIS  (BENJAMIN),  M.D. 
THE    MEDICAL   FORMULARY :   being  a  Collection  of  Prescriptions,  derived 

from  the  writings  and  practice  of  many  of  the  most  eminent  physicians  of  America  and  Europe. 
Together  with  the  usual  Dietetic  Preparations  and  Antidotes  for  Poisons.  To  which  is  added 
an  Appendix,  on  the  Endermic  use  of  Medicines,  and  on  the  use  of  Elher  and  Chloroform.  The 
whole  accompanied  with  a  few  brief  Pharmaceutic  and  Medical  Observations.  Tenth  edition, 
revised  and  much  extended  by  Robert  P.  Thomas,  M.  D.,  Professor  of  Materia  Medica  in  the 
Philadelphia  College  of  Pharmacy.  In  one  neat  octavo  volume,  of  Iwo  hundred  and  ninety-six 
pages.    (Now  Keady.     Revised  a?id  enlarged  to  1854.) 

This  work  has  received  a  very  complete  revision  at  the  hands  of  the  editor,  who  has  made  what- 
ever alterations  and  additions  the  progress  of  medical  and  pharmaceutical  science  has  rendered  ad 
visable,  introducing  fully  the  new  remedial  agents,  and  revising  the  whole  by  the  latest  improvements 
of  the  Pharmacopoeia.  To  accommodate  these  additions,  the  size  of  the  page  has  been  increased, 
and  the  volume  itself  considerably  enlarged,  while  every  elfort  has  been  made  to  secure  the  typo- 
graphical accuracy  which  has  so  long  merited  the  confidence  of  the  profession. 


After  an  examination  of  the  new  matter  and  the 
alterations,  we  believe  the  reputation  of  tiie  work 
built  up  by  the  author,  and  the  late  distinguished 
editor,  will  continue  to  flourisli  under  the  auspices 
of  the  present  editor,  who  has  the  industry  and  accu- 
racy, and,  we  would  say,  conscientiousness  requi- 
site for  the  responsible  task. — American  Journal  of 
Pharmacy,  March,  1854. 


It  will  prove  particularly  useful  to  students  and 
young  prnctitioners,  as  the  most  important  prescrip- 
tions employed  in  modern  practice,  which  lie  scat- 
tered through  our  (medical  literature,  are  here  col- 
lected and  conveniently  arranged  for  reference. — 
Charleston  Med.  Journal  and  Review. 


ERICHSEN    (JOHN), 

V  Professor  of  Surgery  in  University  College,  London,  &c. 

THE  SCIENCE  AND  ART  OF  SURGERY;  being  A  Treatise  on  Surgical 

Injuries,  Diseases,  and  Operations.     Edited  by  John  H.  Brinton,  M.  D.     Illustrated  with 

three  hundred  and  eleven  engravings  on  wood.     In  one  large  and  handsome  octavo  rolume,  oi 

over  nine  hundred  closely  printed  pages.     {Now  Ready .) 

This  is  a  new  work,  brought  up  to  May,  1854. 

It  is,  in  our  humble  judgment,  decidedly  the  best 
book  of  the  kind  in  the  English  language.  Strange 
That  just  such  books  are  notofieuer  produced  by  pub- 
lic teachers  of  surgery  iu  this  country  and  Great 
Britain.  Indeed,  it  is  a  matter  of  great  astonishment, 
but  no  less  true  than  astonishing,  that  of  the  many 
works  on  surgery  republished  in  this  country  within 
the  last  fiileeu  or  twenty  years  as  text-books  for 
medical  students,  this  is  the  only  one,  that  even  ap- 
proximates to  the  fulfilment  of  the  peculiar  wants  of 
young  men  jupt.  entering  upon  the  study  of  this  l)ranch 
of  the  profession. —  WesUTn.Tour.  of  Med.  a?id  Surgery. 

Embracing,  as  will  be  perceived,  the  whole  surgi- 
cal domain,  and  each  division  of  itself  almost  com- 
plete and  perfect,  each  chapter  full  and  explicit,  each 
subject  faithfully  exhibited,  we  can  only  express  our 
extimate  of  it  in  the  aggregate.  We  consider  it  an 
excellent  contribution  to  surgery,  as  probably  the 
best  single  volume  now  exiaiii  on  the  subject,  and 
with  great  pleasure  we  add  it  to  our  textbooks  — 
Nashville  Journal  of  Medicine  and  Surgery. 


Its  value  is  greatly  enhanced  by  a  very  copious 
well-ai-ranged  index.  We  regard  this  as  one  of  the 
most  valuable  contributions  to  modern  surgery.  To 
one  entering  his  novitiate  of  practice,  we  regard  ii 
the  most  serviceable  guide  which  he  can  consult.  He 
will  fittd  a  fulness  of  detail  leading  him  through  every 
step  of  the  operation,  and  not  deserting  him  until  the 
final  issue  of  the  case  is  decided.  For  the  same  rea- 
son we  recommend  it  to  those  whose  routine  of  prac- 
tice lies  in  such  parts  of  the  country  that  they  must 
rarely  encounter  cases  requiring  surgical  manage- 
ment.—5<et^o5co7>e. 

Prof  Erichsen's  work,  for  its  size,  has  not  been 
surpassed;  his  nine  hundred  and  eight  pages,  pro- 
fusely illustrated,  are  rich  in  physiological,  patholo- 
gical, and  operative  suggestions,  doctrines,  details, 
and  processes;  and  will  prove  a  reliable  resource 
for  information,  both  lo  physician  and  surgeon,  in  the 
hour  of  peril.— JV.  0.  Med.  and  Surg.  Journal. 


FERGUSSON  (WILLIAM),  F.  R.  S., 

Professor  of  Surgery  in  King's  College,  London,  &c. 

A  SYSTEM  OF  PRACTICAL  SURGERY.     Fourth  American,  from  the  third 

and  enlarged  London  edition.     In  one  large  and  beautifully  prmted  octavo  volume,  of  about  seven 
hundred  pages,  with  three  hundred  and  ninety-three  handsome  illustrations.     (Just  Issued.) 


The  most  important  subjects  in  connection  w^ith 
practical  surge-iy  which  have  been  more  recently 
brought  under  the  notice  of,  and  discussed  by,  the 
surgeons  of  Great  Britain,  are  fully  and  dispassion- 
ately considered  by  Mr.  Fergusson,  and  that  which 
was  before  wanting  has  now  been  supplied,  so  that 
we  can  now  look  upon  it  as  a  work  on  practical  sur- 
gery instead  of  one  on  operative  surgery  alone.  And 
we  think  the  author  has  shown  a  wise  discretion  in 
making  the  additions  on  surgical  disease  which  are 
to  be  found  in  the  present  volume,  and  has  very 
much  enhanced  its  value;  for,  besides  tw;o elaborate  |  Journal. 

The  addition  of  many  new  pages  makes  this  work 
more  than  ever  indispensable  to  the  student  and  prac- 
titioner.— Ranking^s  Abstract. 


sively  on  operative  surgery  ;  but  this  defect  is  now 
removed,  and  the  book  is  more  than  ever  adapted  for 
the  purposes  of  the  practitioner,  whether  he  confines 
himself  more  strictly  to  the  operative  department, 
or  follows  surgery  on  a  more  comprehensive  scale. — 
Medical  Ti?7ies  and  Gazette. 

No  work  was  ever  written  which  more  nearly 
comprehended  the  necessities  of  the  student  and 
practitioner,  and  was  more  carefully  arranged  to 
that  single  purpose  than  this.— IV.  Y.  Med.  and  Surg. 


chapters  on  the  diseases  of  bones  and  joints,  which 
were  wanting  before,  he  has  headed  each  chief  sec- 
tion of  the  work  by  a  general  description  of  the  sur- 
gical disease  and  injury  of  that  region  of  the  body  j 

which  is  treated  of  in  each,  prior  to  entering  into  the  I  ^  .  _     . 

consideration  of  the  more  special  morbid  conditions  I  lished  of  late  years,  we  know  of  none  we  value 
and  their  treatment.  There  is  also,  as  in  former  j  more  highly  than  the  one  before  us.  It  is  perhaps 
editions,  a  sketch  of  the  anatomy  of  particular  re-  the  very  best  we  have  for  a  text-book  and  for  ordi- 
gions.  There  was  some  ground  formerly  for  the  nary  reference,  being  concise  and  eminently  practi- 
eoraplaint  before  alluded  to,  that  it  dwelt  too  exclu-  |  ca\.— Southern  Med.  and  Surg.  Journal. 


Among  the  numerous  works  upon  surgery  pub- 


FRICK  (CHARLES),  M.  D. 
RENAL    AFFECTIONS;    their  Diagnosis  and  Pathology. 
One  volume,  royal  12mo.,  extra  cloth. 


With  illustrations. 


AND   SCIENTIFIC    PUBLICATIONS. 


1$ 


FOWNES  (GEORGE),   PH.  D.,  See. 
ELEMENTARY    CHEMISTRY;    Theoretical  and  Practical.     With  numerous 

illustrations.  A  new  American,  from  the  last  and  revised  London  edition.  Edited,  with  Addi- 
tions, by  Robert  Bridges,  M.  D.  In  one  large  royal  12mo.  volume,  of  over  550  pages,  with  181 
wood-cuts,  sheep,  or  extra  cloth.     (Now  Ready.) 

The  lamented  death  of  the  author  has  caused  the  revision  of  this  edition  to  pass  into  the  hands  ot 
those  distinguished  chemists,  H.  Bence  Jones  and  A,  W.  Hofmann,  who  have  fully  sustained  its 
reputation  by  the  additions  which  they  have  made,  more  especially  in  the  portion  devoted  to  Organic 
Chemistry,  considerably  increasing  the  size  of  the  volume.  This  labor  has  been  so  thoroughly 
performed,  that  the  American  Editor  has  found  but  little  to  add,  his  notes  consisting  chiefly  of  suck 
matters  as  the  rapid  advance  of  the  science  has  rendered  necessary,  or  of  investigations  which  had 
apparently  been  overlooked  by  the  author's  friends. 

The  volume  is  therefore  again  presented  as  an  exponent  of  the  most  advanced  state  of  chemical 
science,  and  as  not  unworthy  a  continuation  of  the  marked  favor  which  it  has  received  as  an  ele- 
mentary text-book. 


We  know  of  no  better  text-book,  especially  in  the 
difficult  department  of  organic  chemistry,  upon 
w^hich  it  is  particularly  fall  and  satisfactory.  We 
would  recommend  it  to  preceptors  as  a  capital 
"  office  book"  for  their  students  who  are  beginners 
in  Chemistry.  It  is  copiously  illustrated  with  ex- 
cellent wood-cuts,  and  altogether  admirably  "got 
up."— iV.  J.  Medical  Reporter,  March,  1854. 

A  standard  manual,  ^vhich  has  long  enjoyed  the 
reputation  of  embodying  much  knowledge  in  a  small 
space.  The  author  hasachieved  the  difficult  task  of 
condensation  with  masterly  tact.  His  book  is  con- 
cfse  without  being  dry,  and  brief  without  being  too 
dogmatical  or  general. — Virginia  Med.  and  Surgical 
Journal. 


The  work  of  Dr.  Fownes  has  long  been  before 
the  public,  and  its  merits  have  been  fully  appreci- 
ated as  the  best  text-book  on  chemistry  now  in 
existence.  We  do  not,  of  course,  place  it  in  a  rank 
superior  to  the  works  of  Brande,  Graliam,  Turner, 
Gregory,  or  Gmelin,  but  we  say  that,  as  a  work 
for  students,  it  is  preferable  to  any  of  them. — Lon- 
don Journal  of  Medicine. 

A  work  well  adapted  to  the  wants  of  the  student. 
It  is  an  excellent  exposition  of  the  chief  doctrines 
and  facts  of  modern  chemistry.  Thesizeof  the  work, 
and  still  more  the  condensed  yet  perspicuous  style 
in  -which  it  is  written,  al)solve  it  from  the  charges 
very  properly  urged  against  most  manuals  termed 
popular. — Edinburgh  Monthly  Journal  of  Medical 
Science. 


GRAHAM   (THOMAS),   F.  R.  S., 

Professor  of  Chemistry  in  University  College,  London,  &c. 

THE  ELEMENTS  OF  CHEMISTRY.     Including  the  application  of  the  Science 

to  the  Arts.    With  numerous  illustrations.    With  Notes  and  Additions,  by  Robert  Bridges, 
M.  D.,  &e.  &c.     Second  American,  from  the  second  and  enlarged  London  edition 
PART  I.  (Lately  Issvsd)  large  8vo.,  430  pages,  185  illustrations. 
PART  II.  (Preparing)  to  match. 

The  great  changes  which  the  science  of  chemistry  has  undergone  within  the  last  few  years,  ren- 
der a  new  edition  of  a  treatise  like  the  present,  almost  a  new  work.  The  author  has  devoted 
several  years  to  the  revision  of  his  treatise,  and  has  endeavored  to  embody  in  it  every  fact  and 
inference  of  importance  which  has  been  observed  and  recorded  by  the  great  body  of  chemical 
investigators  who  are  so  rapidly  changing  the  face  of  the  science.  In  this  manner  the  work  has 
been  greatly  increased  in  size,  and  the  number  of  illustrations  doubled  ;  while  the  labors  of  the  editor 
have  been  directed  towards  the  introduction  of  such  matters  as  have  escaped  the  attention  of  the 
author,  or  as  have  arisen  since  the  publication  of  the  first  portion  of  this  edition  in  London,  in  1850. 
Printed  in  handsome  style,  and  at  a  very  low  price,  it  is  therefore  confidently  presented  to  the  pro- 
fession and  the  student  as  a  very  complete  and  thorough  text-book  of  this  important  subject. 


GROSS  (SAMUEL  D.),   M.  D., 

Professor  of  Surgery  in  the  Louisville  Medical  Institute,  &c. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES   AND   INJURIES   OF 

THE  URINARY  ORGANS.     In  one  large  and  beautifully  printed  octavo  volume,  of  over  seven 
hundred  pages.     With  numerous  illustrations. 


A  volume  replete  with  truths  and  principles  of  the 
utmost  value  in  the  investigation  of  these  diseases. — 
American  Medical  Journal. 

Dr.  Gross  has  brought  all  his  learning,  experi- 
ence, tact,  and  judgment  to  the  task,  and  has  pro- 
duced a  w^ork  worthy  of  his  high  reputation.  We 
feel  perfectly  safe  in  recommending  it  to  our  read- 
ers as  a  monograph  unequalled  in  interest  and 
practical  value  by  any  other  on  the  subject  in  our 
language. — Western  Journal  of  Med.  and  Surg. 

It  has  remained  for  an  American  writer  to  \vipe 
away  this  reproach  ;  and  so  completely  has  the  task 
been  fulfilled,  that  we  venture  to  predict  for  Dr. 
Gross's  treatise  a  permanent  place  in  the  literature 
of  surgery,  worthy  to  rank  with  the  best  works  of 


this  department  of  art.  We  have,  indeed,  unfeigned 
pleasure  in  congratulating  all  concerned  in  this  pub- 
lication, on  the  result  of  their  labours;  and  expe- 
rience a  feeling  something  like  what  animates  a  long- 
expectant  husbandman,  who,  often  times  disappointed 
by  the  produce  of  a  favorite  field,  is  at  last  agree- 
ably surprised  by  a  stately  crop  which  may  bear 
comparison  -with  any  of  its  former  rivals.  The 
grounds  of  our  high  appreciation  of  the  work\vill 
be  obvious  as  we  proceed;  and  we  doubt  not  that 
the  present  facilities  for  obtaining  American  books 
will  induce  many  of  our  readers  to  verify  our  re- 
commendation by  their  own  perusal  of  it. — British 
and  Foreign  Medico-C hirurgical  Review. 

AVhoever  will  peruse  the  vast  amount  of  valuable 


the  present  age.  Not  merely  is  the  matter  good,  i  practical  information  it  contains,  and  wliich  we 
but  the  getting  up  of  the  volume  is  most  creditable  i  have  been  unable  even  to  notice,  will,  we  think, 
to  transatlantic  enterprise;  the  paper  and  print  '  agree  with  us,  that  there  is  no  work  in  the  Knglislv 
would  do  credit  to  a  first-rate  London  establishment;  language  which  can  make  any  jnst  pretensions  to 
and  the  numerous  wood-cuts  which  illustrate  it,  de-  be  its  equal. — N.  Y.  Journal  of  Medicine. 
monstrale  that  America  is  making  rapid  advances  in  i 

BY  THE  SAME  AUTHOR.      (NoW  Ready.) 

A  PRACTICAL  TREATISE  ON  FOREIGN  BODIES  IN  THE  AIR-PAS- 

SAGES.     In  one  handsome  octavo  volume,  with  illustrations. 

BY  THE  SAME  AUTHOR.     (Preparing.) 

A  SYSTEM  OF  SURQERY;  Diagnostic,  Pathological,  Therapeutic,  and  Opera- 
tive.   With  very  numerous  engravings  on  wood. 


16 


.  '•  y  ;  >  rr  A  ■  ;  T  "Z  :^  i  D  ^  ( i  ;4  .^ 

BLANCHARD   &    LEA'S    MEDICAL 


GRIFFITH  (ROBERT  E.),  M.  D.,  &.C. 

A  UNIVERSAL  FORMULARY,  containing  the  methods  of  Preparing  and  Ad- 

ministering  Officinal  and  other  Medicines.  The  whole  adapted  to  Physicians  and  Pharmaceu- 
tists. Second  Edition,  thoroug-hly  revised,  with  numerous  additions,  by  Robert  P.  Thomas, 
M.  D.,  Professor  of  Materia  Medica  in  the  Philadelphia  College  of  Pharmacy.  In  one  large  an<3 
handsome  octavo  volume,  of  over  six  hundred  pages,  double  columns.     {Jiist  Issued.) 

The  speedy  exhaustion  of  a  large  edition,  and  the  demand  for  a  second,  sufficiently  show  the  posi- 
tion which  this  work  has  so  rapidly  attained  as  an  authoritative  and  convenient  work  of  reference  for 
the  physician  and  pharmaceutist.  The  opportunity  thus  afforded  for  its  improvement  has  not  been 
neglected.  In  its  revision,  Professor  Thomas  (to  whom  this  task  has  been  confided  inconsequence 
of  the  death  of  the  author),  has  spared  no  labor,  in  the  hope  of  rendering  it  the  most  complete  and 
correct  work  on  the  subject  as  yet  presented  to  the  profession  All  the  newly  introduced  articles 
of  the  Materia  Medica  have  been  inserted,  such  formulae  as  had  escaped  the  attention  of  the  author 
have  been  added,  and  the  whole  has  been  most  carefully  read  and  examined,  to  insure  the  absolute 
correctness,  so  indispensable  in  a  work  of  this  nature.  The  amount  of  these  additions  maybe  esti- 
mated from  the  fact  that  not  only  has  the  page  been  considerably  enlarged,  but  the  volume  has  also 
Ijeen  increased  by  about  fifty  pages,  while  the  arrangement  of  the  forraulee  and  the  general  typo- 
graphical execution  will  be  found  to  have  undergone  great  improvement.  To  the  practitioner,  its 
copious  collection  of  all  the  forms  and  combinations  of  the  articles  of  the  Pharmacopoeia  render  it 
an  invaluable  book  of  reference,  while  its  A'ery  complete  embodiment  of  officinal  preparations  of  aUt 
kinds,  derived  from  all  sources,  American,  English,  and  Continental,  make  it  an  indispensable  assisl- 
tant  to  the  apothecary. 


It  was  a  work  requiring  much  perseverance,  and 
when  published  was  looked  upon  as  by  far  the  best 
work  of  its  kind  that  had  issued  t'rom  the  American 
press,  beinjT  free  of  much  of  the  trashy,  and  embrac- 
ing most  of  the  non-officinal  formul.'^e  used  or  known 
in  American,  English,  or  French  practice,  arranged 
under  the  heads  of  the  several  constituentdrugs,  plac- 
ing the  receipt  under  its  more  important  constituent. 
Prof  Thomas  lias  certainly  "improved,"  as  well  as 
added  ;o  this  Formulary,  and  has  rendered  it  addition- 
ally deserving  of  the  confidence  of  pharmaceutists 
and  physicians. — American  Journal  of  Pharmacy. 

We  are  happy  to  announce  a  new  and  improved 
edition  of  this,  one  of  the  most  valuable  and  useful 
works  that  have  emanated  from  an  American  pen. 
It  would  do  credit  to  any  country,  and  will  be  found 
of  daily  usefulness  to  practitioners  of  medicine;  it  is 
better  adapted  to  their  purposes  than  the  dispensato- 
ries.—SoitzAern  Med.  and  Surg.  Journal. 

A  new  edition  of  this  well-known  work,  edited  by 
R.  P.  Thomas,  M  D.,  affords  occasion  for  renewing 
our  commendation  of  so  useful  a  handbook,  which 
ought  to  be  universally  studied  by  medical  men  of 
every  class,  and  made  use  of  by  way  of  reference  by 
ofiice  pupils,  as  a  standard  authority.  It  has  been 
much  enlarged,  and  now  condenses  a  vast  amount 
of  needful  and  necessary  knowledge  in  small  com- 
pass. The  more  of  such  books  the  better  for  the  pro- 
fession and  the  public—  N.  Y.  Med.  Gazette. 


It  is  one  of  the  mo«t  useful  books  a  country  practi- 
tioner can  possibly  have  in  his  possession. — Mtdieal 
Chronicle. 

The  amount  of  useful,  every-day  matter,  for  a  prac- 
ticing physician,  is  really  immense.— jBos^o/i  Mtd, 
and  Surg.  Journal. 

This  is  a  work  of  six  hundred  and  fifty  one  pages. 
embracmg  all  on  the  subject  of  preparing  and  admi- 
nistering medicines  that  can  be  desired  by  the  physi- 
cian and  pharmaceutist. —  Wester7i  Lancet. 

In  short,  it  is  a  full  and  complete  work  of  the  kind, 
and  should  be  in  the  hands  of  every  physician  and 
apothecary. —  O.  Bled,  and  Surg.  Journal 

We  predict  a  great  sale  for  this  work,  and  we  espe- 
ciallv  recommend  it  to  all  tnedical  teachers. — Rich- 

mond  Stethoscope. 

This  edition  of  Dr.  Griffith's  work  has  been  greatly 
imoroved  by  the  revision  and  ample  additions  of  Dr. 
Thomas,  and  is  now,  we  believe,  one  of  the  most 
complete  works  of  its  kind  in  any  language.  The 
additions  amount  to  about  seventy  pages,  and  no 
effort  has  been  spared  to  include  in  them  all  the  re- 
cent improvements  which  have  been  published  in 
medical  journals,  and  sy.slematic  treatisas.  A  work 
of  this  kind  appears  to  us  indispensable  lo  the  physi- 
cian, and  there  is  none  we  can  more  cordially  recom- 
mend.— iV.  y.  Journal  of  Medicine. 


BY   THE  SAME  AUTHOR. 


MEDICAL  BOTANY;  or^  a  Description  of  all  the  more  important  Plants  used 
in  Medicine,  and  of  their  Properties,  Uses,  and  Modes  of  Administration.  In  one  large  octavo 
volume,  of  704  pages,  handsomely  printed,  with  nearly  350  illustrations  on  wood. 


GLUGE  (GOTTLIEB),   M.  D., 

Professor  of  Physiology  and  Pathological  Anatomy  in  the  University  of  Brussels,  &c. 

AN  ATLAS   OF   PATHOLOGICAL   HISTOLOGY.     Translated,  with  Notes 

and  Additions,  by  Joseph  Leidy,  M.  D.,  Professor  of  Anatomy  in  the  University  of  Pennsylva- 
nia. In  one  volume,  very  large  imperial  quarto,  with  three  hundred  and  twenty  figures,  plain 
and  colored,  on  twelve  copperplates. 


This  being,  as  far  as  we  know,  the  only  work  in 
which  pathological  histology  is  separately  treated 
of  in  a  comprehensive  manner,  it  will,  we  think,  for 
this  reason,  be  of  infinite  service  to  those  who  desire 
to  investigate  the  subject  systematically,  and  -who 
have  felt  the  difficulty  of  arranging  in  their  mind 


the  unconnected  observations  of  a  great  number  of 
authors.  The  development  of  the  morbid  tissues, 
and  the  formation  of  abnormal  products,  may  now 
be  followed  and  studied  with  the  same  ease  and 
satisfaction  as  the  best  arranged  system  of  phy- 
siology.— American  Med.  Journal. 


GREGORY  (WILLIAM),   F.  R.  S.  E., 

Professor  of  Chemistry  in  the  University  of  Edinburgh,  &c. 

LETTERS    TO  A  CANDID    INQUIRER    ON    ANIMAL 

In  one  neat  volume,  royal  12mo.,  extra  cloth. 


MAGNETISM. 


GARDNER  (D.  PEREIRA),  M.  D.  ^ 

MEDICAL  CHEMISTRY,  for  the  use  of  Students  and  the  Profession:  being  a 
Manual  of  the  Science,  with  its  Applications  to  Toxicology,  Physiology,  Therapeutics,  Hygiene, 
&c.     In  one  handsome  royal  i2mo.  volume,  with  illustrations. 


iiyiO  iUOiDUUi 


AND   SCIENTIFIC    PUBLICATIONS.  17 

HASSE  (C.  E.),   M.  D. 
AN  ANATOMICAL  DESCllIPTION  OF  THE  DISEASES  OP  RESPIRA- 
TION AND  CIRCULATION.     Translated  and  Edited  by  Swaine.    In  one  volume,  octavo. 

HARRISON  (JOHN),   M.  D. 
AN   ESSAY  TOWARDS  A  CORRECT  THEORY  OF  THE  NERVOUS 

Si^STEM.    In  one  octavo  volume,  292  pages. 

HUNTER  (JOHN). 
TREATISE  ON  THE  VENEREAL  DISEASE.     With  copious  Additions,  by 

Db.  Ph.  Ricord,  Surgeon  to  the  Venereal  Hospital  of  Paris.     Edited,  with  additional  Notes,  by 
F.  J.  BuMSTEAD,  M.  D.     In  one  octavo  volume,  with  plates     {Now  Ready.)    ^W  See  Ricord. 
Also,  HUNTER'S  COMPLETE  WORKS,  with  Memoir,  Notes,  &c.  &c.    In  four  neat  octavo 
volumes,  with  plates. 

HUGHES   (H.    M.),  M.  D., 

Assistant  Physician  to  Guy's  Hospital,  tea. 

A  CLINICAL  INTRODUCTION   TO  THE   PRACTICE   OF  AUSCULTA-' 

TION,  and  other  Modes  of  Physical  Diagnosis,  in  Diseases  of  the  Lungs  and  Heart.     Second 
American  from  the  Second  and  Improved  London  Edition.  In  one  royal  ]2mo.  vol.  {Now  Ready.) 
It  has  been  carefully  revised  throughout.     Some  small  portions  have  been  erased ;  much  has 
been,  I  trust,  amended;  and  a  great  deal  of  new  matter  has  been  added;  so  that,  though  funda- 
mentally it  is  the  same  book,  it  is  in  many  respects  a  new  work. — Preface. 


HORNER  (WILLIAM  E.),  M.  D., 
Professor  of  Anatomy  in  the  University  of  Pennsylvania. 

SPECIAL   ANATOMY   AND    HISTOLOGY.     Eighth  edition.     Extensively 

revised  and  modified.    In  two  large  octavo  volumes,  of  more  than  one  thousand  pages,  handh 

somely  printed,  with  over  three  hundred  illustrations. 

This  work  has  enjoyed  a  thorough  and  laborious  revision  on  the  part  of  the  author,  with  the 
view  of  bringing  it  fully  up  to  the  existing  state  of  knowledge  on  the  subject  of  general  and  special 
anatomy.  To  adapt  it  more  perfectly  to  the  wants  of  the  student,  he  has  introduced  a  large  number 
of  additional  wood-engravings,  illustrative  of  the  objects  described,  while  the  publishers  have  en- 
deavored to  render  the  mechanical  execution  of  the  work  worthy  of  the  extended  reputation  which 
it  has  acquired.  The  demand  which  has  carried  it  to  an  EIGHTH  EDITION  is  a  sufficient  evi- 
dence of  the  value  of  the  work,  and  of  its  adaptation  to  the  wants  of  the  student  and  professional 
reader. 

HOBLYN  (RICHARD  D.),  A.  M . 
A  DICTIONARY  OF   THE   TERMS   USED  IN  MEDICINE   AND   THE 

COLLATERAL   SCIENCES.     Second  and  Improved  American  Edition.     Revised,  with  nu- 
merous Additions,  from  the  second  London  edition,  by  Isaac  Hays,  M.  D.,  &c.    In  one  large 
royal  12mo.  volume,  of  over  four  hundred  pages,  double  columns.     {Nearly  Ready.) 
In  passing  this  work  a  second  time  through  the  press,  the  editor  has  subjected  it  to  a  very  tho- 
rough revision,  making  such  additions  as  the  progress  of  science  has  rendered  desirable,  and  sup- 
plying any  omissions  that  may  have  previously  existed.     As  a  concise  and  convenient  Dictionary 
of  Medical  Terms,  at  an  exceedingly  low  price,  it  will  therefore  be  found  of  great  value  to  the  stu- 
dent and  practitioner. 

HOPE  (J.),   M.  D.,  F.  R.  S.,  &tc. 
A  TREATISE  ON  THE   DISEASES    OF   THE    HEART   AND   GREAT 

VESSELS.    Edited  by  Pennock.    In  one  volume,  octavo,  with  plates,  572  pages. 

JONES  (C.  HANDFIELD),  F.  R.  S.,  8l  EDWARD  H.  SIEVEKING,  M.D., 

Assistant  Physicians  and  Lecturers  in  St.  Mary's  Hospital,  London. 

A  MANUAL  OF  PATHOLOGICAL  ANATOMY.     With  400  engravings  on 

wood.  In  one  large  and  handsome  octavo  volume,  of  about  seven  hundred  pages.  {Now  Ready.) 
This  work  will  supply  a  want  which  has  been  felt  of  a  volume  which,  within  a  reasonable  size, 
should  contain  a  clear  and  connected  view  of  the  present  advanced  state  of  pathological  anatomy, 
embodying  the  numerous  investigations  and  discoveries  of  recent  observers,  who,  with  the  aid  of 
the  microscope,  have  so  greatly  enlarged  the  boundaries  of  pathological  science.  This  has  Ijeen 
the  aim  of  the  authors,  and  their  reputation  is  sufficient  guarantee  that  the  object  has  been  attained. 
The  publi?-hers  have  omitted  nothing  that  is  requisite  to  the  full  appreciation  and  understanding  of 
the  subject,  and  the  very  numerous  illustrations  with  which  the  volume  abounds,  will,  it  is  hoped, 
fully  elucidate  the  details  and  descriptions.  r 

JONES  (T.  WHARTON),   F.  R.  S.,  &ic. 
THE  PRINCIPLES  AND  PRACTICE   OF   OPHTHALMIC    MEDICINE 

AND  SURGERY.    Edited  by  Isaac  Hays,  M.  D.,  &c.     In  one  very  neat  volume,  large  royal 
12mo.,  of  529  pages,  with  four  plates,  plain  or  colored,  and  ninety-eight  wood-cuts. 

migrht  become,  a  manual  for  daily  reference  and 


I  The  work  amply  sustains,  in  every  point  the  al- 
rejtdy  high  reputation  of  the  author  as  an  ophthalmic 
Burgeon  as  well  as  a  physiologist  and  pathologist. 
The  book  is  evidently  the  result  of  much  labor  and 
research,  and  has  been  written  with  the  greatest 
care  and  attention.  We  entertain  little  doubt  that 
tills  book  will  become  what  its  author  hoped  it 


consultation  by  the  student  and  the  general  practi- 
tioner. The  work  is  marked  by  that  correctness, 
clearness,  and  precision  of  style  which  distinguish 
all  the  productions  of  the  learned  author. — British 
and  Foreign  Medical  Review, 


18 


BLANCHARD   &   LEA'S   MEDICAL 


KIRKES  (WILLIAM   SENHOUSE),    M.  D., 

Demonstrator  of  Morbid  Anatomy  at  St.  Bartholomew's  Hospital,  &c.;  and 

JAMES   PAGET,  F.  R.  S., 

Lecturer  on  General  Anatomy  and  Physiology  in  St.  Bartholomew's  Hospital. 

A  MANUAL  OF  PHYSIOLOaY.  Second  American,  from  the  second  and 
improved  London  edition.  Witii  one  hundred  and  sixty-five  illustration!?.  In  one  larg-e  and 
handsome  royal  r2mo.  volume,     pp.550.     {Just  Issued.) 

In  the  present  edition,  the  Manual  of  Physiology 
has  been  brought  up  to  the  actual  condition  of  th 


science,  and  fully  sustains  the  reputation  which  it 
has  already  so  deservedly  attained.  We  consider 
the  work  of  MM.  Kirkes  and  Paget  to  constitute  one 
of  the  very  best  handbooks  of  Physiology  we  possess 
— presenting  just  such  an  outline  of  the  science,  com- 
prising an  account  of  its  leading  facts  and  generally 
admitted  principles,  as  the  student  requires  during 
his  attendance  upon  a  course  of  lectures,  or  for  re- 
ference whilst  preparing  for  examination.  The  text 
is  fully  and  ably  illustrated  by  a  series  of  very  supe- 
rior wood-engravings,  by  which  a  comprehension  of 
some  of  the  more  intricate  of  the  subjects  treated  of 
is  greatly  facilitated. — Am.  Medical  Journal. 

We  need  only  say,  that,  without  entering  into  dis- 
cussions of  unsettled  questions,  it  contains  all  the 
recent  improvements  in  tliis  department  of  medical 
science.  For  the  student  beginning  this  study,  and 
the  practitioner  who  has  but  leisure  to  refresh  his 
memory,  this  book  is  invaluable,  as  it  contains  all 


that  it  is  important  to  know,  without  special  details, 
which  are  read  with  interest  only  by  those  who 
would  make  a  specialty,  or  desire  to  possess  a  criti- 
cal knowledge  of  the  subject. — Charleston  Medical 
Journal. 

One  of  the  best  treatises  that  can  be  put  into  the 
hands  of  the  student. — London  Medical  Gazette. 

The  general  favor  with  which  the  first  edition  of 
this  Avork  was  received,  and  its  adoption  as  a  favor- 
ite text-book  by  many  of  our  colleges,  will  insure  a 
large  circulation  to  this  improved  edition.  It  will 
fully  meet  the  wants  of  the  student.  —  Southern 
Med.  and  Surg.  Journal. 

Particularly  adapted  to  those  who  desire  to  pos- 
sess a  concise  digest  of  the  facts  of  Human  Physi- 
ology.— British  and  Foreign  Med.-Chirurg.  Review. 

We  conscientiously  recommend  it  as  an  admira- 
ble "  Handbook  of  Physiology." — London  Journal 
of  Medicine. 


KNAPP  (F.),  PH.  D.,  &,c. 

TECHNOLOG-Y ;  or,  Chemistry  applied  to  the  Arts  and  to  Manufactures.  Edited, 
with  numerous  Notes  and  Additions,  by  Dr.  Edmund  Ronalds  and  Dr.  Thomas  Richardson. 
First  American  edition,  with  Notes  and  Additions,  bj'-  Prof.  Walter  R.  Johnson.  In  two  hand- 
some octavo  volumes,  printed  and  illustrated  in  the  highest  style  of  art,  with  about  five  hundred 
wood-engravings. 


PHYSIOLOGICAL 

(Preparing.) 


LEHMANN. 
CHEMISTRY.      Translated  by  George  E.  Day,  M.  D. 


LEE  (ROBERT),   M.  D.,  F.  R.  S.,  &c. 

CLINICAL    MIDWIFERY;    comprising  the   Histories  of  Five  Hundred  and 

Forty-five  Case?  of  Difficult,  Preternatural,  and  Complicated  Labor,  with  Commentaries.    From 
the  second  London  edition.     In  one  royal  12mo.  volume,  extra  cloth,  of  238  pages. 


LA    ROCHE   (R.),    M.  D.,  &,c. 

PNEUMONIA ',  its  Supposed  Connection,  Pathological  and  Etiological,  with  Au- 
tumnal Fevers,  including  an  Inquiry  into  the  Existence  and  Morbid  Agency  of  Malaria.  In  one 
handsome  octavo  volume,  extra  cloth,  of  500  pages. 

the  periodical  press,  and  yet  in  the  work  before  us 
he  has  exhibited  an  amount  of  industry  and  learning, 
research  and  ability,  beyond  what  we  are  accustomed 
to  discover  in  modern  medical  writers;  while  his 
own  extensive  opportunities  for  observation  and 
experience  have  been  improved  by  the  most  laudable 
diligence,  and  display  a  familiarity  with  the  whole 
subject  in  every  aspect,  which  commands  both  our 
respect  and  confidence.  As  a  corrective  of  prevalent 
and  mischievous  error,  sought  to  be  propagated  by 
novices  and  innovators,  we  could  wish  that  Dr.  La 
Roche's  book  could  be  widely  read. — N.  Y.  Medical 
Gazette. 


A  more  simple,  clear,  and  forcible  exposition  of 
the  groundless  nature  and  dangerous  tendency  of 
certain  pathological  and  etiological  heresies,  has 
seldom  been  presented  to  our  notice. — N.  Y.  Journal 
of  Medicine  and  Collateral  Science,  March,  1854. 

This  work  should  be  carefully  studied  by  Southern 
physicians,  embodying  as  it  does  the  reflections  of 
an  original  thinker  and  close  observer  on  a  subject 
peculiarly  their  own. — Virginia  Med.  and  Surgical 
Journal. 

The  author  had  prepared  us  to  expect  a  treatise 
from  him,  by  his  brief  papers  on  kindred  topics  in 


BY  THE  SAME  AUTHOR.      (In  PresS.) 

YELLOW  FEVER,  considered   in  its  Historical,  Pathological,  and   Etiological 
Relations.     In  one  very  large  and  handsome  octavo  volume. 


LONGET   (F.  A.) 

TREATISE  ON  PHYSIOLOGY.  With  numerous  Illustrations.  Translated 
from  the  French  by  F.  G.  Smith,  M.  D.,  Professor  of  Institutes  of  Medicine  in  the  Pennsylvania 
Medical  College.    {Preparing.) 


AND   SCIENTIFIC   PUBLICATIONS.  19 

LAWRENCE  (W.),   F.  R.  S.,  Sec. 
A  TREATISE    ON    DISEASES    OF    THE    EYE.     A    new  edition,   edited, 

with  numerous  additions,  and  243  illustrations,  by  Isaac  Hays,  M.  D.,  Surgeon  to  Wills  Hospi- 
tal, &c.     In  one  very  large  and  handsome  octavo  volume,  of  950  pages,  strongly  bound  in  leather 
with  raised  bands.     {Now  Ready.) 
This  work  is  thoroughly  revised  and  brought  up  to  1854. 

This  work  is  so  universally  recognized  as  the  standard  authority  on  the  subject,  that  the  pub- 
Mshers  in  presenting  this  new  edition  have  only  to  remark  that  in  its  preparation  the  editor  has 
carefully  revised  every  portion,  introducing  additions  and  illustrations  wherever  the  advance  of 
science  has  rendered  them  necessary  or  desirable.  In  this  manner  it  will  be  found  to  con- 
tain over  one  hundred  pages  more  than  the  last  edition,  while  the  list  of  wood-engravings 
has  been  increased  by  sixty-seven  figures,  besides  numerous  improved  illustrations  substituted 
for  such  as  were  deemed  imperfect  or  unsatisfactory.  The  various  important  contributions  to 
ophthalmological  science,  recently  made  by  Dalrymple,  Jacob,  Walton,  Wilde,  Cooper,  &c., 
both  in  the  form  of  separate  treatises  and  contributions  to  periodicals,  have  been  carefully 
examined  by  the  editor,  and,  combined  with  the  results  of  his  own  experience,  have  been 
freely  introduced  throughout  the  volume,  rendering  it  a  complete  and  thorough  exponent  of 
the  most  advanced  state  of  the  subject. 

In  a  future  number  we  shall  notice  more  at  length  ■  octavo  pages-  has  enabled  both  author  and  editor  to 
this  admirable  treatise— the  safest  guide  and  most  '  do  justice  to  all  the  details  of  this  subject,  and  con- 
comprehensive  work  of  reference,  which  is  Avithin  !  dense  in  this  single  volume  the  present  state  of  our 
the  reach  of  all  classes  of  the  profession. — Sietho-  ]  knowledge  of  tlie  whole  science  in  this  department, 
scope,  March,  1854.  I  whereby  its  practical  value  cannot  be  excelled.  We 

j  heartily  commend  it,  especially  as  a  book  of  refe- 

This  standard  text-book  on  the  department  of  :  renee,  indispensable  in  every  medical  library.  The 
which  it  treats,  has  not  been  superseded,  by  any  or  |  additions  of  the  American  editor  very  greatly  en- 
all  of  the  numerous  publications  on  the  subject  hance  the  value  of  the  work,  exhibiting  the  learning 
heretofore  issued.  Nor  with  the  multiplied  improve-  !  and  experience  of  Dr.  Hays,  in  the  light  in  which  he 
nients  of  Dr.  Hays,  the  American  editor,  is  it  at  all  i  ought  to  be  held,  as  a  standard  authority  on  all  sub- 
likely  that  this  great  work  will  cease  to  merit  the  ;  jects  appertaining  to  this  specialty,  to  which  he  has 
confidence  and  preference  of  students  or  practition-  j  rendered  so  many  valuable  contributions. — N.  Y. 
ers.    Its  ample  extent — nearly  one  thousand  large  j  Medical  Gazette. 

BY   THE   SAME   AUTHOR. 

A  TREATISE  ON  RUPTURES;  from  the  fifth  London  edition.    In  one  octavo 

volume,  sheep,  480  pages. 


LUDLOW    (J.    L.),    M.  D., 

Lecturer  on  Clinical  Medicine  at  the  Philadelphia  Almshouse,  &c. 

A  MANUAL  OF  EXAMINATIONS  upon  Anatomy  and  Physiology,  Surgery, 

Practice  of  Medicine,  Chemistry,  Obstetrics,  Materia  Medica,  Pharmacy,  and  Therapeutics. 
Designed  for  Students  of  Medicine  throughout  the  United  States.  A  new  edition,  revised  and 
extensively  improved.  In  one  large  royal  12mo.  volume,  with  several  hundred  illustrations. 
{Prepart?ig.) 

LISTON   (ROBERT),   F.  Fl.  S.,  &c. 
LECTURES  ON  THE  OPERATIONS  OF  SURGERY,  and  on  Diseases  and 

Accidents  requiring  Operations.  Edited,  with  numerous  Additions  and  Alterations,  by  T.  D. 
MiJTTER,  M.  D.     In  one  large  and  handsome  octavo  volume,  of  566  pages,  with  216  wood-cuts. 


LALLEMAND  (M.). 
THE  CAUSES,  SYMPTOMS,  AND  TREATMENT  OF  SPERMATOR- 

RHCEA.  Translated  and  edited  by  Henry  J.  McDougal.  In  one  volume,  octavo,  320  pages. 
Second  American  edition.     {Now  Ready.) 

LARDNER  (DIONYSIUS),   D.  C.  L.,  &c. 
HANDBOOKS    OF    NATURAL    PHILOSOPHY    AND    ASTRONOMY. 

Kevised,  with  numerous  Additions,  by  the  American  editor.  First  Course,  containing  Mecha- 
nics, Hydrostatics,  Hydraulics,  Pneumatics,  Sound,  and  Optics.  In  one  large  royal  l2rao. 
volume,  of  750  pages,  with  424  wood-cuts.  Second  Course,  containing  Heat,  Electricity,  Mag- 
netism, and  Galvanism,  one  volume,  large  royal  12mo.,  of  450  pages,  with  250  illustrations. 
Third  Course  (  now  ready),  containing  Meteorology  and  Astronomy,  in  one  large  volume,  royal 
12mo.  of  nearly  eight  hundred  pages,  with  thirty-seven  plates  and  two  hundred  wood-cuts.  The 
whole  complete  in  three  volumes,  of  about  two  thousand  large  pages,  with  over  one  thousand 
figures  on  steel  and  wood. 

The  various  sciences  treated  in  this  work  will  be  found  brought  thoroughly  up  to  the  latest  period. 

factory  manner  the  information   they  desire. — The 
Virginia  Med.  and  Surg.  Journal. 


The  work  furnishes  a  very  clear  and  satisfactory 
account  of  our  knowledge  in  the  important  depart- 
ment of  science  of  which  it  treats.  Although  the 
medical  schools  of  this  country  do  not  include  the 
study  of  physics  in  their  course  of  instruction,  yet 
no  student  or  practitioner  should  be  ignorant  of  its 
laws.  Besides  being  of  constant  application  in  prac- 
tice, such  knowledge  is  of  inestimable  utility  in  fa- 
eilitating  the  study  of  other  branches  of  science.  To 
students,  then,  and  to  those  who,  having  already  en- 
tered upon  the  active  pursuits  of  business,  are  desir- 
ous to  sustain  and  improve  their  knowledge  of  the 
general  truths  of  natural  philosophy,  we  can  recom- 
mend this  work  as  supplying  in  a  clear  and  aatis- 


The  present  treatise  is  a  most  complete  digest  of 
all  that  has  been  developed  in  relation  to  the  great 
forces  of  nature.  Heat,  Magnetism,  and  Electricity. 
Their  laws  are  elucidated  in  a  manner  both  pleasing 
and  familiar,  and  at  the  same  time  perfectly  intelli- 
gible to  the  student.  The  illustrations  are  suffi- 
ciently numerous  and  appropriate,  and  altogether 
we  can  cordially  recommend  the  work  as  well-de- 
serving the  notice  both  of  the  practising  physician 
and  the  student  of  medicine. — The  Med.  Examiner. 


BLANCHARD   &   LEA'S   MEDICAL 


MEIGS  (CHARLES  D.),  M.  D., 

;  Professor  of  Obstetrics,  &c.  in  the  Jefferson  Medical  College,  Philadelphia. 

ON    THE    NATURE,    SIGNS,    AND    TREATMENT    OF    CHILDBED 

FEVER.     In  a  Series  of  Letters  addressed  to  the  Students  of  his  Class.     In  one  handsome 
octavo  volume,  of  three  hundred  and  sixty-five  pages.    {Now  Ready.) 


BY  THE  SAME   AUTHOR. 

WOMAN :  HER  DISEASES  AND  THEIR  REMEDIES.     A  Series  of  Lee- 

tures  to  his  Class.     Third  and  Improved  edition.     In  one  large  and  beautifully  printed  octavo 

volume.     {Just  Issued.     Revised  and  enlarged  to  1854.) 

The  gratifying  appreciation  of  his  labors,  as  evmced  by  the  exhaustion  of  two  large  impressions 
ol'  this  work  within  a  few  years,  has  not  been  lost  upon  the  author,  who  has  endeavored  in  eA'ery 
way  to  render  it  worthy  of  the  favor  with  which  it  has  been  received.  The  opportunity  thiw 
afforded  for  a  second  revision  has  been  improved,  and  the  work  is  now  presented  as  in  every  way 
superior  to  its  predecessors,  additions  and  alterations  having  been  made  whenever  the  advance  of 
science  has  rendered  them  desirable.  The  typographical  execution  of  the  work  will  also  be  found 
to  have  undergone  a  similar  improvement  and  the  work  is  now  confidently  presented  as  in  every 
way  worthy  the  position  it  has  acquired  as  the  standard  American  text-book  on  the  Diseases  of 
Females. 


It  contains  a  vast  amount  of  practical  knowledge. 
by  one  who  has  accurately  observed  and  retained 
ihe  experience  of  many  years,  and  who  tells  the  re- 
sult in  a  free,  familiar,  and  pleasant  manner. — Buh- 
lin  Quarterly  Journal. 

Tliere  is  an  off-hand  fervor,  a  glow,  and  a  warm- 
heartedness infecting  the  effort  of  Dr.  Meigs,  which 
is  entirely  captivating,  and  which  absolutely  hur- 
ries the  reader  through  from  beginning  to  end.  Be- 
eides,  the  book  teems  with  solid  instruction,  and 
it  shows  the  very  highest  evidence  of  ability,  viz., 
the  clearness  with  which  the  information  "is  pre- 
sented. We  know  of  no  better  test  of  one's  under- 
standing a  subject  than  the  evidence  of  the  power 
of  lucidly  explaining  it.  The  most  elementary,  as 
well  as  the  obscurest  subjects,  under  the  pencil  of 
Prof.  Meigs,  are  isolated  and  made  to  stand  out  in 
such  bold  relief,  as  to  produce  distinct  impressions 
upon  the  mind  and  memory  of  the  reader.  —  The 
Charleston  Med.  Journal. 


Professor  Meigs  has  enlarged  and  amended  this 
great  work,  for  such  it  unquestionably  is,  havin? 
passed  the  ordeal  of  criticism  at  home  and  abroad, 
but  been  improved  thereby  ;  for  in  this  new  edition 
the  author  has  introduced  real  improvements,  and 
increased  the  value  and  utility  of  the  book  fm- 
measurably.  It  presents  so  many  novel,  bright, 
and  sparkling  thoughts  ;  such  an  exuberance  of  new 
ideas  on  almost  every  page,  that  we  confess  our- 
selves to  have  become  enamored  with  the  book 
and  its  author ;  and  cannot  withhold  our  congratu- 
lations from  our  Philadelphia  confreres,  tliat  such  a 
teacher  is  in  their  service.  We  regret  that  our 
limits  will  not  allow  of  a  more  extended  notice  of 
this  work,  but  must  content  ourselves  with  thus 
commending  it  as  worthy  of  diligent  i>erusal  by 
physicians  asM'^ell  as  students,  who  are  seeking  Iro 
be  thoroughly  instructed  in  the  important  practical 
subjects  of  which  it  treats. — N.  Y.  Med.  Gazette. 


BY   THE   SAME   AUTHOR. 

OBSTETRICS :  THE  SCIENCE  AND   THE   ART.     Second  edition,  revised 

and  improved.     With  one  hundred  and  thirty-one  illustrations.     In  one  beautifully  printed  octavo 
volume,  of  seven  hundred  and  fifty-two  large  pages.     {Lately  Published.) 

The  rapid  demand  for  a  second  edition  of  this  work  is  a  sufficient  evidence  that  it  has  supplied 
a  desideratum  of  the  profession,  notwithstanding  the  numerous  treatises  on  the  same  subject  which 
have  appeared  within  the  last  few  years.  Adopting  a  system  of  his  own,  the  author  has  combined 
the  leading  principles  of  his  interesting  and  difficult  subject,  with  a  thorough  exposition  of  its  rules 
of  practice,  presenting  the  results  of  long  and  extensive  experience  and  of  familiar  acquaintance 
with  all  the  modern  writers  on  this  department  of  medicine.  As  an  American  Treatise  on  Mid- 
wifery, which  has  at  once  assumed  the  position  of  a  classic,  it  possesses  peculiar  claims  to  the  at- 
tention and  study  of  the  practitioner  and  student,  while  the  numerous  alterations  and  revisions 
which  it  has  undergone  in  the  present  edition  are  shown  by  the  great  enlargement  of  the  work, 
which  is  not  only  increased  as  to  the  size  of  the  page,  but  also  in  the  number.  Among  other  addi- 
tions may  be  mentioned 

A  NEW  AND  IMPORTANT  CHAPTER  ON  "CHILDBED  FE7ER." 


BY  THE  SAME  AUTHOR.     {Now  Ready.) 

A  TREATISE  ON  ACUTE  AND  CHRONIC  DISEASES  OF  THE  NECK 

OF  THE  UTERUS.     With  numerous  plates,  drawn  and  colored  from  nature  in  the  higliest 
style  of  art.    In  one  handsome  octavo  volume,  extra  cloth. 

The  object  of  the  author  in  this  work  has  been  to  present  in  a  small  compass  the  practical  results 
of  his  long  experience  in  this  important  and  distressing  class  of  diseases.  The  great  changes  intro- 
duced into  practice,  and  the  accessions  to  our  knowledge  on  the  subject,  within  the  last  few  years, 
resulting  from  the  use  of  the  metroscope,  brings  within  the  ordinary  practice  of  every  physician 
numerous  cases  which  were  formerly  regarded  as  incurable,  and  renders  of  great  value  a  work  like 
the  present  combining  practical  directions  for  diagnosis  and  treatment  with  an  ample  series  of  illus- 
trations, copied  accurately  from  colored  drawings  made  by  the  author,  after  nature.  No  such  accu- 
rate delineations  of  the  pathology  of  the  neck  of  the  uterus  have  heretofore  been  given,  requiring, 
as  they  do  the  rare  combination  of  physician  and  artist,  and  their  paramount  importance  to  life 
physician  in  whose  practice  such  cases  are  frequent,  is  too  evident  to  be  dwelt  upon,  while  in 
artistic  execution  they  are  far  in  advance  of  anything  of  the  kind  as  yet  produced  in  this  country. 


BY  THE   SAME  AUTHOR. 

OBSERVATIONS   ON    CERTAIN    OF    THE    DISEASES 

CHILDREN.    In  one  handsome  octavo  volume,  of  214  pages. 


OF    YOUNG 


AND   gCIENTIFIG   PUBLICATIONS. 


21 


MILLER  (JAMES),  F.  R.  S.  E., 

Professor  of  Surgery  in  the  University  of  Edinburgh,  &c. 

PRINCIPLES  OF  SURGERY.     Third  American,  from  the  second  and  revised 

Edinburgh  edition.  Revised,  with  Additions,  by  F.  W.  Sargent,  M.  D.,  author  of  '<  Minor  Sur- 
gery," &c.  In  one  large  and  very  beautiful  volume,  of  seven  hundred  and  fifty-two  pages,  with 
two  hundred  and  forty  exquisite  illustrations  on  wood. 

The  publishers  have  endeavored  to  render  the  present  edition  of  this  work,  in  every  point  of  me- 
chanical execution,  worthy  of  its  very  high  reputation,  and  they  confidently  present  it  to  the  pro- 
fession as  one  of  the  handsomest  volumes  as  yet  issued  in  this  country. 
This  edition  is  far  superior,  both  in  the  abundance  I  guage.     This  opinion,  deliberately  formed  after  a 


and  quality  of  its  material,  to  any  of  the  preceding 
We  hope  it  will  be  extensively  read,  and  the  sound 
principles  which  are  herein  taught  treasured  up  for 
future  application.  The  work  takes  rank  with 
Watson's  Practice  of  Physic  ;  it  certainly  does  not 
fall  behind  that  great  work  in  soundness  of  princi- 
ple or  depth  of  reasoning  and  research.  No  physi- 
cian who  values  his  reputation,  or  seeks  the  interests 
of  his  clients,  can  acquit  himself  before  his  God  and 
Hie  world  without  making  himself  familiar  with  the 
sound  and  philosophical  views  developed  in  the  fore- 

5oing  book. — Ntw  Orleans  Medical  and  Surgical 
ournal. 

Without  doubt  the  ablest  exposition  of  the  prin- 
ciples of  that  branch  of  the  healing  art  in  any  lan- 

BY   THE   SAME   AUTHOR.      {NoW  Ready.) 

THE  PRACTICE  OF  SURGERY.  Third  American  from  the  second  Edin- 
burgh edition.  Edited,  with  Additions,  by  F.  W.  Sargent,  M.  D  ,  one  of  the  Surgeons  to  Will's 
Hospital,  &c.  Illustrated  by  three  himdred  and  nineteen  engravings  on  wood.  In  one  large 
octavo  volume,  of  over  seven  hundred  pages.  ' 

This  new  edition  will  be  found  greatly  improved  and  enlarged,  as  Avell  by  the  addition  of  much 

new  matter  as  by  the  introduction  of  a  large  and  complete  series  of  handsome  illustrations.    An 

equal  improvement  exists  in  the  mechanical  execution  of  the  work,  rendering  it  in  every  respect 

a  companion  volume  to  the  "Principles." 


careful  study  of  the  first  edition,  we  have  iiad  no 
cause -to  change  on  examining  the  second.  This 
edition  has  undergone  thorough  revision  by  the  au- 
thor ;  many  expressions  have  been  modified,  and  a 
mass  of  new  matter  introduced.  The  book  is  got  up 
in  the  finest  style,  and  is  an  evidence  of  the  progress 
of  typography  in  our  country. — Charleston  Medical 
Journal  and  Review. 

We  recommend  it  to  both  student  and  practitioner, 
feeling  assured  that  as  it  now  comes  to  us,  it  pre- 
sents the  most  satisfactory  exposition  of  the  modern 
doctrines  of  the  principles  of  surgery  to  be  found  in 
any  volume  in  any  language. — N.  Y.  Journal  of 
Medicine . 


No  encomium  of  ours  could  add  to  the  popularity 
of  Miller's  Surgery.  Its  reputation  in  this  country 
ia  unsurpassed  by  that  of  any  other  work,  and,  when 
taken  in  connection  with  the  author's  Principles  of 
Surgery,  constitutes  a  whole,  without  reference  to 
which  no  conscientious  surgeon  would  be  willing 
to  practice  his  art.  The  additions,  by  Dr.  Sargent, 
have  materially  enhanced  the  value  of  the  work. — 
Southern  Medical  and  Surgical  Journal. 

It  is  seldom  that  two  volumes  have  ever  made  so 
profound  an  impression  in  so  short  a  time  as  the 
"  Principles"  and  the  "  Practice"  of  Surgery  by 
Mr.  Miller — or  so  richly  merited  the  reputation  they 
have  acquired.  The  author  is  an  eminently  sensi- 
ble, practical,  and  well-informed  man,  who  knows 
exactly  what  he  is  talking  about  and  exactly  how  to 
talk  it. — Kentucky  Medical  Recorder. 

The  two  volumes  together  form  a  complete  expose 
9f  the  present  state  of  Surgery,  and  they  ought  to  be 
on  the  shelves  of  every  surgeon. — N.  J.  Med.  Re- 
porter. 


By  the  almost  unanimous  voice  of  the  profession, 
his  works,  both  on  the  principles  and  practice  of 
surgery  have  been  assigned  the  highest  rank.  If  we 
were  limited  to  but  one  work  on  surgery,  that  one 
should  be  Miller's,  as  we  regard  it  superior  to  aU 
others. — St.  Louis  Med.  and  Surg.  Journal. 

The  author  distinguished  alike  as  a  practitioner 
and  writer,  has  in  this  and  his  "  Principles,"  pre- 
sented to  the  profession  one  of  the  most  compl  ete  and 
reliable  systems  of  Surgery  extant.  His  style  of 
writing  is  original,  impressive,  and  engaging,  ener- 
getic, concise,  and  lucid.  Few  have  the  faculty  of 
condensing  so  much  in  small  space,  and  at  the  same 
time  so  persistently  holding  the  attention;  indeed, 
he  appears  to  make  the  very  process  of  condensation 
a  means  of  eliminating  attractions.  Whether  as  a 
text-book  for  students  or  a  book  of  reference  for 
practitioners,  it  cannot  be  too  strongly  recommend- 
ed.— Southern  Journal  of  the  Medical  and  Physical 
Sciences. 


MALGAIGNE  (J.  F.). 
OPERATIVE  SURGERY,  based  on  Normal  and  Pathological  Anatomy.     Trans- 
lated from  the  French,  by  Frederick  Brittan,  A.  B.,  M.  D.    With  numerous  illustrations  on 
wood.    In  one  handsome  octavo  volume,  of  nearly  six  hundred  pages. 

To  express  in  a  few  words  our  opinion  of  IVTal- 
gaigne's  work,  we  unhesitatingly  pronounce  it  the 


We  have  long  been  accustomed  to  refer  to  it  as  one 
of  the  most  valuable  text-books  in  our  library. — 
Buffalo  Med.  and  Surg.  Journal. 

Certainly  one  of  the  best  books  published  on  ope- 
rative surgery.— Edinburgh  Medical  Journal. 


very  best  guide  in  suro^ical  operations  that  has  come 
before  the  profession  in  any  language. — Charleston 
Med.  and  Surg.  Journal. 


MOHR  (FRANCIS),  PH.  D.,  AND  REDWOOD  (TH  EOPH  I  LUS). 

PRACTICAL    PHARMACY.     Comprising  the  Arrangements,  Apparatus,  and 
Manipulations  of  the  Pharmaceutical  Shop  and  Laboratory.    Edited,  with  extensive  Additions, 
by  Prof.  William  Procter,  of  the  Philadelphia  College  of  Pharmacy.    In  one  handsomely 
printed  octavo  volume,  of  570  pages,  with  over  500  engravings  on  wood. 
It  is  a  book,  however,  which  will  be  in  the  hands 
of  almost  everyone  who  is  much  interested  in  phar- 
maceutical operations,  as  we  know  of  no  other  pub- 
lication so  well  calculated  to  fill  a  void  long  felt. — 
Medical  Examiner. 

The  book  is  strictly  practical,  and  describes  only 
manipulations  or  methods  of  performing  the  nume- 
rous processes  the  pharmaceutist  has  to  go  through, 
in  the  preparation  and  manufacture  of  medicines, 
together  with  all  the  apparatus  and  fixtures  necea- 


sary  thereto.  On  these  matters,  this  work  is  very 
full  and  complete,  and  details,  in  a  style  uncom- 
monly clear  and  lucid,  not  only  the  more  compli- 
cated and  difficult  processes,  but  those  not  less  im- 
portant ones,  the  most  simple  and  common. — Buffalo 
Medical  Journal. 

The  country  practitioner  who  is  obliged  to  dis- 
pense his  own  medicines,  will  find  it  a  most  valuable 
assistant. — Monthly  Journal  and  Retrospect. 


22 


BLANCHARD   &   LEA'S   MEDICAL 


MACLISE   (JOSEPH),    SURGEON. 
SURGICAL   ANATOMY.     Forming   one  volume,   very  large   imperial   quarto. 

With  sixty-eight  large  and  splendid  Plates,  drawn  in  the  best  style  and  beautifully  colored.  Con- 
taining one  hundred  and  ninety  Figures,  many  of  them  the  size  of  life.  Together  with  copiou.s 
and  explanatory  letter-press.  Strongly  and  handsomely  bound  in  extra  cloth,  being  one  of  the 
cheapest  and  best  executed  Surgical  works  as  yet  issued  in  this  country. 

Copies  can  be  sent  by  mail,  in  five  parts,  done  up  in  stout  covers.  ^ 

This  great  work  being  now  concluded,  the  publishers  confidently  present  it  to  the  attention  of  the 
profession  as  worthy  in  every  respect  of  their  approbation  and  patronage.  No  complete  work  of 
the  kind  has  yet  been  published  in  the  English  language,  and  it  therefore  will  supply  a  want  long 
felt  in  this  country  of  an  accurate  and  comprehensive  Atlas  of  Surgical  Anatomy  to  which  the 
student  and  practitioner  can  at  all  times  refer,  to  ascertain  the  exact  relative  position  of  the  various 
portions  of  the  human  frame  towards  each  other  and  to  the  surface,  as  well  as  their  abnormal  de- 
viations. The  importance  of  such  a  work  to  the  student  in  the  absence  of  anatomical  material,  and 
to  the  practitioner  when  about  attempting  an  operation,  is  evident,  while  the  price  of  the  book,  not- 
withstanding the  large  size,  beauty,  and  finish  of  the  very  numerous  illustrations,  is  so  low  as  to 
place  it  within  the  reach  of  every  member  of  the  profession.  The  publishers  therefore  confidently 
anticipate  a  very  extended  circulation  for  this  magnificent  work. 


of  keeping  up  his  anatomical  knowlecige. — Medical 
Times. 

The  mechanical  execution  cannot  be  excelled. — 
Transylvania  Medical  Journal. 

A  work  which  has  no  parallel  in  point  of  accu- 
racy and  cheapness  in  the  English  language. — JV.  Y. 
Journal  of  Medicine. 

To  all  engaged  in  the  study  or  practice  of  their 
profession,  such  a  work  is  almost  indispensable. — 
Dublin  Quarterly  Medical  Journal. 

No  practitioner  whose  means  will  admit  should 
fail  to  possess  it. — Ranking^s  Abstract. 

Country  practitioners  will  find  these  plates  of  ini- 
mense  value. — N.  Y.  Medical  Gazette. 

We  are  extremely  gratified  to  announce  to  the 
profession  the  completion  of  this  truly  magnificeat 
work,  which,  as  a  whole,  certainly  stands  unri- 
valled, both  for  accuracy  of  drawing,  beauty  of 
coloring,  and  all  the  requisite  explanations  of  the 
subject  in  hand. — The  New  Orleans  Medical  and 
Surgical  Journal. 

This  is  by  far  the  ablest  work  on  Surgical  Ana- 
tomy that  has  come  under  our  observation.  W« 
know  of  no  other  work  that  would  justify  a  stu- 
dent, in  any  degree,  for  neglect  of  actual  dissec- 
tion. Jn  those  sudden  emergencies  that  so  often 
arise,  and  which  require  the  instantaneous  command 
of  minute  anatomical  knowledge,  a  work  of  this  kind 
keeps  the  details  of  the  dissecting-room  perpetually 
fresh  in  the  memory. — The  Western  Journal  of  Medi- 
cine and  Surgery. 

The  very  low  price  at  which  this  work  is  furnished,  and  the  beauty  of  its  execiition, 
require  an  extended  sale  to  compensate  the  publishers  for  the  heavy  expenses  incurred. 


One  of  the  greatest  artistic  triumphs  of  the  age 
in  Surgical  Anatomy. — British  American  Medical 
Journal. 

Too  much  cannot  be  said  in  its  praise ;  indeed, 
we  have  not  language  to  do  it  justice. — Ohio  Medi- 
cal and  Surgical  Journal. 

The  most  admirable  surgical  atlas  we  have  seen. 
To  the  practitioner  deprived  of  demonstrative  dis- 
sections upon  the  human  subject,  it  is  an  invaluable 
companion. — N.  J.  Medical  Reporter. 

The  most  accurately  engraved  and  beautifully 
colored  plates  we  have  ever  seen  in  an  American 
book — one  of  the  best  and  cheapest  surgical  works 
ever  published. — Buffalo  Medical  Journal. 

It  is  very  rare  that  so  elegantly  printed,  so  well 
iilustriiied,  and  so  useful  a  work,  is  offered  at  so 
moderate  a  price. — Charleston  Medical  Journal. 

Its  plates  can  boast  a  superiority  which  places 
khem  almost  beyond  the  reach  of  competition. — Medi- 
cal Examiner. 

Every  practitioner,  we  think,  should  have  a  work 
of  this  kind  within  reach. — Southern  Medical  and 
Surgical  Journal. 

No  such  lithographic  illustrations  of  surgical  re- 
gions have  hitherto,  we  think,  been  given. — Boston 
Medical  and  Surgical  Journal. 

As  a  surgical  anatomist,  Mr.  Maclise  has  proba- 
bly no  superior. — British  and  Foreign  Medico-Chi- 
rurgical  Review. 

Of  great  value  to  the  student  engaged  in  dissect- 
ing, and  to  the  surgeon  at  a  distance  from  the  means 


MULLER  (PROFESSOR  J.),   M.  D. 
PRINCIPLES  OF  PHYSICS  AND  METEOROLOGY. 


Edited,  with  Addi- 


tions, by  R.  Eglesfeld  Griffith,  M.  D.    In  one  large  and  handsome  octavo  volume,  extra 
cloth,  with  550  wood-cuts,  and  two  colored  plates. 

The  Physics  of  Mailer  is  a  work  superb,  complete,  I  tion  to  the  scientific  records  of  this  country  may  be 
unique  :  the  greatest  want  known  to  English  Science  [  duly  estimated  by  the  fact  that  the  cost  of  the  origi- 
could  not  have  been  better  supplied.  The  work  is  I  nal  drawings  and  engravings  alone  has  exceeded  tiie 
of  surpassing  interest.    The  value  of  this  contribu-  |  sum  of  £2,000. — Lancet. 


MAYNE  (JOHN),  M.  D.,  M.  R.  G.  S. 
A  DISPENSATORY  AND  THERAPEUTICAL  REMEMBRANCER.   Com- 

prising  the  entire  lists  of  Materia  Medica,  with  every  Practical  Formula  contained  in  the  three 
Britifih  Pharmacopoeias.  With  relative  Tables  subjoined,  illustrating,  by  upwards  of  six  hundred 
and  sixty  examples,  the  Extemporaneous  Forms  and  Combinations  suitable  for  the  different 
Medicines.  Edited,  with  the  addition  of  the  Formulae  of  the  United  States  Pharmacoposia,  by 
R.  Eglesfeld  Griffith,  M.  D.    In  one  12mo.  volume,  extra  cloth,  of  over  300  large  pages. 


MATTEUCCI  (CARLO). 
LECTURES  ON  THE  PHYSICAL  PHENOMENA  OF  LIVINa  BEINGS. 

Edited  by  J.  Pereira,  M.  D.    In  one  neat  royal  12mo.  volume,  extra  cloth,  with  cuts,  388  pages. 


AND  SCIENTIFIC   PUBLICATIONS.  23 

NEILL  (JOHN),  M.  D., 

'•■  Surgeon  to  the  Pennsylvania  Hospital,  &c.;  and 

FRANCIS  GURNEY   SMITH,   M.  D., 
Professor  of  Institutes  of  Medicine  in  the  Pennsylvania  Medical  College. 

AN  ANALYTICAL  COMPENDIUM  OF  THE  VARIOUS  BRANCHES 

OF  MEDICAL  SCIENCE  ;  for  the  Use  and  Examination  of  Students.  Second  edition,  revised 
and  improved.  In  one  very  large  and  handsomely  printed  royal  12mo.  volume,  of  over  one 
thorteand  pages,  with  three  hundred  and  fifty  illustrations  on  wood.  Strongly  bound  in  leather, 
with  raised  bands. 

The  speedy  sale  of  a  large  impression  of  this  work  has  afforded  to  the  authors  gratifying  evidence 
oi  the  correctness  of  the  views  which  actuated  them  in  its  preparation.  In  meeting  the  demand 
for  a  second  edition,  they  have  therefore  been  desirous  to  render  it  more  worthy  of  the  favor  with 
which  it  has  been  received.  To  accomplish  this,  they  have  spared  neither  time  nor  labor  in  embo- 
dying in  it  such  discoveries  and  improvements  as  have  been  made  since  its  first  appearance,  and 
such  alterations  as  have  been  suggested  by  its  practical  use  in  the  class  and  examination-room. 
Considerable  modifications  have  thus  been  introduced  throughout  all  the  departments  treated  of  in 
the  volume,  but  more  especially  in  the  portion  devoted  to  the  "Practice  of  Medicine,"  which  has 
been  entirely  rearranged  and  rewritten.  The  authors  therefore  again  submit  their  work  to  the 
profession,  with  the  hope  that  their  efforts  may  tend,  however  humbly,  to  advance  the  great  cause 
of  medical  education. 

Notwithstanding  the  enlarged  size  and  improved  execution  of  this  work,  the  price  has  not  been 
increased,  and  it  is  confidently  presented  as  one  of  the  cheapest  volumes  now  before  the  profession. 


In  the  rapid  course  of  lectures,  where  work  for 
the  students  is  heavy,  and  review  necessary  for  an 
examination,  a  compend  is  not  only  valuable,  but 
it  is  almost  a  sine  qua  non.  The  one  before  us  is, 
in  most  of  the  divisions,  the  most  unexceptionable 
erf  all  books  of  the  kind  that  we  know  of.  The 
newest  and  soundest  doctrines  and  the  latest  im- 
provements and  discoveries  are  explicitly,  though 
concisely,  laid  before  the  student.  Of  course  it  is 
useless  for  us  to  recommend  it  to  all  last  course 
students,  but  there  is  a  class  to  whom  we  very 
sincerely  commend  this  cheap  book  as  worth  its 
weight  in  silver  —  that  class  is  the  graduates  in 
medicine  of  more  than  ten  years'  standing,  who 
have  not  studied  medicine  since.  They  will  perhaps 
find  out  from  it  that  the  science  is  not  exactly  now 
what  it  was  when  they  left  it  off. — The  Stethoscope 


Having  made  free  use  of  this  volume  in  our  ex- 
aminations of  pupils,  we  can  speak  from  experi- 
ence in  recommending  it  as  an  admirable  compend 
for  students,  and  as  especially  useful  to  preceptors 
who  examine  their  pupils.  It  will  save  the  teacher 
much  labor  by  enabling  him  readily  to  recall  all  of 
the  points  upon  which  his  pupils  should  be  ex- 
amined. A  work  of  this  sort  should  be  in  the  hands 
of  every  one  who  takes  pupils  into  his  office  with  a 
view  of  examining  them;  and  this  isunquestionablj' 
the  best  of  its  class.  Let  every  practitioner  who  has 
pupils  provide  himself  with  it,  and  he  will  find  the 
labor  of  refreshing  his  knowledge  so  much  facilitated 
that  he  will  be  able  to  do  justice  to  his  pupils  at  very 
little  cost  of  time  or  trouble  to  himself. — TransyU 
vania  Med.  Journal. 


•  NELIGAN  (J.    MOORE),  M.  D.,  M.  R.  I.  A.,  &c. 

A   PRACTICAL   TREATISE    ON   DISEASES    OF   THE    SKIN.     In  one 

neat  royal  12mo.  volume,  of  334  pages. 


.^^j  OWEN  (PROF.    R.), 

■'*  Author  of  Lectures  on  Comparative  Anatomy,"  '*  Archetype  of  the  Skeleton,"  &c. 

ON  THE  DIFFERENT  FORMS  OF  THE  SKELETON,  AND  OF  THE 

TEETH.     One  vol.  roj'-al  12mo.,  with  numerous  illustrations.     {IVow  Ready.) 
The  name  of  the  distinguished  author  is  a  sufficient  guarantee  that  this  little  volume  will  prove 
a  satisfactory  manual  and  guide  to  all  students  of  Comparative  Anatomy  and  Osteology.     The  im- 
portance of  this  subject  in  geological  investigations  will  also  render  this  work  a   most  valuable 
assistant  to  those  interested  in  that  science. 


PHILLIPS  (BENJAMIN),   F.  R.  S.,  &c. 
SCROFULA;    its  Nature,  its  Prevalence,  its  Causes,  and  the  Principles  of  its 
Treatment.    In  one  volume,  octavo,  with  a  plate. 


PANCOAST  (J.),  M.  D., 

Professor  of  Anatomy  in  the  Jefferson  Medical  College,  Philadelphia,  &c. 

OPERATIVE  SURGERY;  or,  A  Description  and  Demonstration  of  the  various 
Processes  of  the  Art ;  including  all  the  New  Operations,  and  exhibiting  the  State  of  Surgical 
Science  in  its  present  advanced  condition.  Complete  in  one  royal  4to.  volume,  of  380  pages  of 
letter-press  description  and  eighty  large  4to.  plates,  comprising  486  illustrations.  Second  edition, 
improved. 

Blanchard  &  Lea  having  become  the  publishers  of  this  important  book,  have  much  pleasure  in 
oflering  it  to  the  profession. 

This  excellent  work  is  constructed  on  the  model 
of  the  French  Surgical  Works  by  Velpeau  and  Mal- 
gaigne;  and,  so  far  as  the  English  language  is  con- 


cerned, we  are  proud  as  an  American  to  say  that, 
OF  ITS  KIND  IT  HAS  NO  SUPERIOR. — N.  Y.  Journal  of 
Medicine. 


PARKER   (LANGSTON), 

Surgeon  to  the  Queen's  Hospital,  Birmingham. 

THE  MODERN  TREATMENT  OF  SYPHILITIC  DISEASES,  BOTH  PRL 

MARY  AND  SECONDARY;  comprisingtheTreatment  of  Constitutional  and  Confirmed  Syphi- 
lis, by  a  safe  and  successful  method.  With  numerous  Cases,  Formulae,  and  Clinical  Observa- 
tions. From  the  Third  and  entirely  rewritten  London  edition.  In  one  neat  octavo  volume. 
{Now  Ready.) 

'  j  mux  ](flLiv«iiii8-'tK>ow  \o  iiB  dfli  dsitiv;  o)  soila»»eq 


24 


BLANCHARD   &   LEA'S   MEDICAL 


(Now  Complete,) 

PEREIRA  (JONATHAN),  M.  D.,  F.  R.  S.,  AND  L.  S. 

THE    ELEMENTS    OF    MATERIA    MEDICA    AND    THERAPEUTICS. 

Third  American  edition,  enlarged  and  improved  by  the  author ;  including  Notices  of  most  of  the 
Medicinal  Substances  in  use  in  the  civilized  world,  and  forming  an  Encyclopaedia  of  Materia 
Medica.  Edited,  with  Additions,  by  Joseph  Cakson,  M.  D.,  Professor  of  Materia  Mediea  and 
Pharmacy  in  the  University  of  Pennsyivania.  In  two  very  large  octavo  volumes  of  2100  pages, 
on  small  type,  with  over  four  hundred  and  fifty  illustrations. 
Volume  I. — Lately  issued,  containing  the  Inorganic  Materia  Medica,  over  800  pages,  with  144 

illustrations. 
Volume  II.— Now  ready,  embraces  the  Organic  Materia  Medica,  and  forms  a  very  large  octavo 
volume  of  1250  pages,  with  two  plates  and  three  hundred  handsome  wood-cuts. 
The  present  edition  of  this  valuable  and  standard  work  will  enhance  in  every  respect  its  well- 
deserved  reputation.  The  care  bestowed  upon  its  revision  by  the  author  may  be  estimated  by  the 
fact  that  its  size  has  been  inci-eased  by  about  five  hundred  pages.  These  additions  have  extended 
to  every  portion  of  the  work,  and  embrace  not  only  the  materials  aflbrded  by  the  recent  editions  of 
the  pharmacopoeias,  but  also  all  the  important  information  accessible  to  the  care  and  industry  of 
the  author  in  treatises,  essays,  memoirs,  monographs,  and  from  correspondents  in  various  parts  of 
the  globe.  In  this  manner  the  work  comprises  the  most  recent  and  reliable  information  respecting 
all  the  articles  of  the  Materia  Medica,  their  natural  and  commercial  history,  chemical  and  thera- 
peutical properties,  preparation,  uses,  doses,  and  modes  of  administration,  brought  up  to  the  present 
time,  with  a  completeness  not  to  be  met  with  elsewhere.  A  considerable  portion  of  the  work 
which  preceded  the  remainder  in  London,  has  also  enjoyed  the  advantage  of  a  further  revision  by 
the  author  expressly  for  this  country,  and  in  addition  to  this  the  editor,  Professor  Carson,  has  made 
whatever  additions  appeared  desirable  to  adapt  it  thoroughly  to  the  U.  S.  Pharmacopoeia,  and  to 
the  wants  of  the  American  profession.  An  equal  improvement  will  likewise  be  observable  in  every 
department  of  its  mechanical  execution.  It  is  printed  from  new  type,  on  good  white  paper,  with  a 
greatly  extended  and  improved  series  of  illustrations. 

Gentlemen  who  have  the  first  volume  are  recommended  to  complete  their  copies  without  delay. 
The  first  volume  will  no  longer  be  sold  separate. 


When  we  remember  that  Philology,  Natural  His- 
tory, Botany,  Chemistry,  Physics,  and  the  Micro- 
scope, are  all  brought  forward  to  elucidate  the  sub- 
ject, one  cannot  fail  to  see  that  the  reader  has  here 
a  work  worthy  of  the  name  of  an  encyclopedia  of 
Materia  Medica.  Our  own  opinion  of  its  merits  is 
that  of  its  editors,  and  also  that  of  the  whole  profes- 
sion, both  of  this  and  foreign  countries— namely, 
"  that  in  copiousness  of  details,  in  extent,  variety, 
and  accuracy  of  information,  and  in  lucid  explana- 
tion of  difficult  and  recondite  subjects,  it  surpasses 
all  other  works  on  Materia  Medica  hitherto  pub- 
lished." We  cannot  close  this  notice  without  allud- 
ing to  the  special  additions  uf  the  American  editor, 
which  pertain  to  the  prominent  vegetable  produc- 
tions of  this  country,  and  to  the  directions  of  the 
United  States  Pharmacopcsia,  in  connection  with  all 
the  articles  contained  in  the  volume  which  are  re- 
ferred to  by  it.  The  illustrations  have  been  increased, 
atid  this  edition  by  Dr.  Carson  cannot  well  be  re- 
garded in  any  other  light  than  that  of  a  treasure 
which  should  be  found  in  the  library  of  every  physi- 
cian.— New  York  Journal  of  Medical  and  Collateral 
Science,  March,  1854. 

The  third  edition  of  his  "Elements  of  Materia 


Medica,  although  completed  under  the  supervision  of 
others,  is  by  far  the  most  elaborate  treatise  in  the 
English  language,  and  will,  while  medical  literatune 
is  cherished,  continue  a  monument  alike  honorable 
to  his  genius,  as  to  his  learning  and  industry. — 
American  Journal  of  Pharmacy,  March,  1854. 

The  work,  in  its  present  shape,  and  so  far  as  can 
be  judged  from  the  portion  before  the  public,  forms 
the  most  comprehensive  and  complete  treatise  on 
materia  medica  extant  in  the  English  language.— 
Dr.  Pereira  has  been  at  great  pains  to  introduce 
into  his  work,  not  only  all  the  information  on  the 
natural,  chemical,  and  commercial  history  of  medi- 
cines, which  might  be  serviceable  to  the  physician 
and  surgeon,  but  whatever  might  enable  his  read- 
ers to  understand  thoroughly  the  mode  of  prepar- 
ing and  manufacturing  various  articles  employed? 
either  for  preparing  medicines,  or  for  certain  pur- 
poses in  the  arts  connected  with  materia  medica 
and  the  practice  of  medicine.  The  accounts  of  the 
physiological  and  therapeutic  eflects  of  remedies  are 
given  with  great  clearness  and  accuracy,  and  in  a 
manner  calculated  to  interest  as  M^ell  as  instruct 
the  reader.— TAe  Edinburgh  Medical  and  Surgical 
Journal. 


AJTT' 


PEASELEE  (E.  R.),   M.  D., 

Professor  of  Anatomy  and  Physiology  in  Dartmouth  College,  &c. 

HUMAN  HISTOLOGY,  in  its  applications  to  Physiology  and  General  Pathology; 

designed  as  a  Text-Book  for  Medical  Students.    With  numerous  illustrations.     In  one  handsonie 

royal  12mo.  volume.     (Preparing.) 

The  subject  of  this  work  is  one,  the  growing  importance  of  which,  as  the  basis  of  Anatomy  and, 
Phvsiology,  demands  for  it  a  separate  volume.  The  book  will  therefore  supply  an  acknowledged 
deficiency  in  medical  text-books,  while  the  name  of  the  author,  and  his  experience  as  a  teacher  for 
the  last  thirteen  years,  is  a  guarantee  that  it  will  be  thoroughly  adapted  to  the  use  of  the  student. 

PIRRIE  (WILLIAM),  F.  R.  S.  E., 

Professor  of  Surgery  in  the  University  of  Aberdeen. 

THE    PRINCIPLES  AND  PRACTICE   OF   SURGERY.     Edited  by  John 

Neill,  M.  D.,  Demonstrator  of  Anatomy  in  the  University  of  Pennsylvania,  Surgeon  to  the 
Pennsylvania  Hospital,  &c.  Li  one  very  handsome  octavo  volume,  of  780  pages,  with  316  illus- 
(Just  Issued.) 


trations. 

We  know  of  no  other  surgical  work  of  a  reason- 
able size,  wherein  there  is  so  much  theory  and  prac- 
tice, or  where  subjects  are  more  soundly  or  clearly 
taught. — The  Stethoscope. 

There  is  scarcely  a  disease  of  the  bone  or  soft 
parts,  fracture,  or  dislocation,  that  is  not  illustrated 
by  accurate  wood-engravings.  Then,  again,  every 
instrument  employed  by  the  surgeon  is  thus  repre- 
sented. These  engravings  are  not  only  correct,  but 
really  beautiful,  showing  the  astonishing  degree  of 
perfaetion  to  which  the  art  of  wood- engraving  has 


arrived.  Prof.  Pirrie,  in  the  work  before  us,  has 
elaborately  discussed  the  principles  of  surgery,  and 
a  safe  and  effectual  practice  predicated  upon  them. 
Perhaps  no  work  upon  this  subject  heretofore  issued 
is  so  full  upon  the  science  of  the  art  of  surgery. — 
Nashville  Journal  of  Medicine  and  Surgery. 

One  of  the  best  treatises  on  surgery  in  the  English 
language. — Canada  Med.  Journal. 

Our  impression  is,  that,  as  a  manual  for  student*, 
Pirrie's  is  the  best  work  extant.— Western  Med.  and 
Surg.  Journal. 


AND   StJIENTIFia   PUBLICATIONS. 


25 


RAMSBOTHAM  (FRANCIS  H.),   M.D. 
THE  PRINCIPLES  AND  PRACTICE  OF  OBSTETRIC  MEDICINE  AND 

SURGERY",  in  reference  to  the  Process  of  Parturition.    Sixth  American,  from  the  last  London 

edition.    Illustrated  with  one  hundred  and  forty-eight  Figures,  on  fifty-five  Lithographic  Plates. 

In  one  large  and  heuidsomely  printed  volume,  imperial  octavo,  with  520  pages. 

In  this  edition,  the  plates  have  all  been  redrawn,  and  the  text  carefully  read  and  corrected.    It 
is  therefore  presented  as  in  every  way  worthy  the  favor  with  which  it  has  so  long  been  received. 
From  Prof.  Hodge,  of  ths  University  of  Pa. 

To  the  American  public,  it  is  most  vahiabie,  from  its  intrinsic  undoubted  excellence,  and  as  beiny 
the  best  authorized  exponent  of  British  Midwifery.  Its  circulation  will,  I  trust,  be  extensive  throughout 
our  country. 

We  recommend  the  student  who  desires  to  mas- 
ter this  difficult  subject  with  the  least  possible 
trouble,  to  possess  himself  at  once  of  a  copy  of  this 
work. — American  Journal  of  the  Med.  Sciences. 

It  stands  at  the  head  of  the  long  list  of  excellent 
obstetric  w^orks  published  in  the  last  few  years  in 
Great  J3ritiiin,  Ireland,  and  the  Continent  of  Eu- 
rope. We  consider  this  book  indispensable  to  the 
library  of  every  physician  engaged  in  the  practice 
of  midwifery. — Southern  Med.  and  Surg.  Journal. 


When  the  whole  profession  is  thus  unanimous 
in  placing  such  a  work  in  the  very  first  rank  as 
regards  the  extent  and  correctness  of  all  the  details 
of  the  theory  and  practice  of  so  important  a  branch 
of  learning,  our  commendation  or  condemnation 
would  be  of  little  consequence;  but  regarding  it 
as  the  most  useful  of  all  works  of  the  kind,  we 
think  it  but  an  act  of  justice  to  urge  its  claims 
upon  the  profession. — N.  O.  Med.  Journal. 


RICORD  (P.),   IVl.  D., 

Surgeon  to  the  Hopital  du  Midi,  Paris,  &c. 

ILLUSTRATIONS  OF  SYPHILITIC  DISEASE.  Translated  from  the  French, 

by  Thomas  F.  Betton,  M.  D.  With  the  addition  of  a  History  of  Syphilis,  and  a  complete  Bib- 
liography and  Formulary  of  Remedies,  collated  and  arranged,  by  Paul  B.  Goddabd,  M.D.  With 
fifty  large  quarto  plates,  comprising  one  hundred  and  seventeen  beautifully  colored  illustrations. 
In  one  large  and  handsome  quarto  volume. 

Blanchard  &  Lea  having  purchased  the  remainder  of  this  valuable  work,  which  was  originally 
sold  as  a  subscription  book,  are  now  prepared  to  offer  it  to  the  profession.  It  is  universally  known 
as  one  of  the  handsomest  volumes  as  yet  presented  m  this  country,  and  as  containing  the  only  ex- 
tended and  thorough  series  of  illustrations  on  the  subject. 

BY  THE  SAME  AUTHOR.      (NoW  Ready.) 

A  TREATISE  ON  THE  VENEREAL  DISEASE.    By  John  Hunter,  F.  R.  S. 

With  copious  Additions,  by  Ph.  Ricord,  M.  D.  Edited,  with  Notes,  by  Freeman  J.  Bumstead, 
M.  D.    In  one  handsome  octavo  volume,  with  plates. 

From  the  Translator's  Preface. 

"  M.  Ricord's  annotations  to  Hunter^s  Treatise  on  the  Venereal  Disease  were  first  published  at 
Paris,  in  1840,  in  connection  with  Dr.  G.  Richelot's  translation  of  the  work,  including  the  contri- 
butions of  Sir  Everard  Home  and  Mr.  Babington.  In  a  second  edition,  which  has  recently  ap- 
peared, M.  Ricord  has  thoroughly  revised  his  part  of  the  work,  bringing  it  up  to  the  knowledge  of 
the  present  day,  and  so  materially  increasing  it  that  it  now  constitutes  full  one-third  of  the  volume. 

"  This  publication  has  been  received  with  great  favor  by  the  French,  both  because  it  has  placed 
within  their  reach  an  important  work  of  Hunter,  and  also  because  it  is  the  only  recent  practical 
work  which  M.  Ricord  has  published,  no  edition  of  his  Traite  des  Maladies  vineriennes  having 
appeared  for  the  last  fifteen  years." 


Every  one  will  recognize  the  attractiveness  and 
value  which  this  work  derives  from  ihus  presenting 
ihe  opinions  of  these  two  masters  side  by  side.  But, 
it  must  be  admitted,  what  has  made  the  fortune  of 
the  book,  is  the  fact  that  it  contains  the  "  most  com- 
plete embodiment  of  the  veritable  doctrines  of  the 
Hopital  du  Midi,"  which  has  ever  been  made  public. 
The  doctrinal  ideas  of  M.  Ricord,  ideas  which,  if  not 
universally  adopted,  are  incontestably  dominant,  have 
heretofore  only  been  interpreted  by  more  or  less  skilful 
secretaries,  sometimes  accredited  and  sometimes  not. 


In  the  notes  to  Hunter,  the  master  substitutes  him- 
self for  his  interpreters,  and  gives  his  original  thoughts 
to  the  world,  in  a  summary  form  it  is  true,  but  m  a 
lucid  and  perfectly  intelligible  manner.  In  conclu- 
sion we  can  say  that  this  is  incontestably  the  best 
treatise  on  syphilis  with  which  we  are  acquainted, 
and,  as  we  do  not  often  employ  the  phrase,  we  may 
be  excused  for  expressing  the  hope  that  it  may  find 
a  place  in  the  library  of  every  physician  — Virginia 
Med.  and  Surg.  Journal. 


BY   THE  SAME   AUTHOR. 

LETTERS  ON  SYPHILIS,  addressed  to  the  Chief  Editor  of  the  Union  Medicale. 
With  an  Introduction,  by  Amedee  Latour.  Translated  by  W.  P.  Lattimore,  M.  D.  In  one  neat 
octavo  volume. 

Blanchard  &  Lea  are  now  the  publishers  of  this  valuable  work. 

From  the  Translator's  Preface. 

To  those  who  have  listened  to  the  able  and  interesting  lectures  of  our  author  at  the  Hopital  da 

Midi,  this  volume  will  need  no  commendation;  while  to  those  who  have  not  had  the  pleasure  to 

which  we  allude,  the  book  will  commend  itself  by  the  truths  it  contains,  told  as  they  are  in  the 

same  inimitable  style  in  which  M.  Ricord  delivers  his  clinical  lectures. 


BY  THE   SAME   AUTHOR. 


A  PRACTICAL  TREATISE  ON  VENEREAL  DISEASES.     With  a  Thera- 

peutical  Summary  and  Special  Formulary.    Translated  by  Sidney  Doane,  M.  D.   Fourth  edition. 
One  volume,  octavo,  340  pages. 


26 


BLANCHARD   &   LEA'S   MEDICAL 


RIGBY  (EDWARD),   M.  D., 

(T  Physician  to  the  General  Lying-in  Hospital,  &c. 

A   SYSTEM   OF  MIDWIFERY.     With   Notes  and  Additional  Illustrations. 

Second  American  Edition.    One  volume  octavo,  422  pages. 


ROYLE  (J.  FORBES),   M.  D. 
MATERIA  MEDIC  A  AND  THERAPEUTICS;  including  the  Preparations  of 

the  Pharmacopoeias  of  London,  Edinburgh,  Dublin,  and  of  the  United  States.  With  many  new 
medicines.  Edited  by  Joseph  Carson,  iVI.  D.,  Professor  of  Materia  Medica  and  Pharmacy  ia 
the  University  of  Pennsylvania.  With  ninety-eight  illustrations.  In  one  large  octavo  volume, 
of  about  seven  hundred  pages. 


This  work  is,  indeed,  a  most  valuable  one,  and 
will  fill  up  an  important  vacancy  that  existed  be- 
tween Dr.  Pereira's  most  learned  and  complete 
system  of  Materia  Medica,  and   the  class  of  pro- 


ductions on  the  other  extreme,  which  are  neces- 
sarily imperfect  from  their  small  extent. — British 
and  Foreign  Medical  Revieiv. 


SKEY  (FREDERICK  C),   F.  R.  S.,  &,c. 

OPERATIVE  SURGERY.     In  one  very  handsome  octavo  volume  of  over  650 
pages 


with  about  one  hundred  wood-cuts. 
Its  literary  execution  is  superior  to  most  surgical 
treatises.    It  abounds  in  excellent  moral  hints,  and 
is  replete  with  original  surgical  expedients  and  sug- 
gestions.— Buffalo  Med.  and  Surg.  Journal. 

With  high  talents,  extensive  practice,  and  a  long 
experience,  Mr.  Skey  is  perhaps  competent  to  the 
task  of  writing  a  complete  work  on  operative  sur- 
gery.— Charleston  Med.  Journal. 


We  cannot  withhold  from  this  work  our  high  com- 
mendation. Students  and  practitioners  will  find  it  an 
invaluable  teacher  and  guide  upon  every  topic  con- 
nected with  this  department. — N.  Y.  Medical  Ga^ 
zette. 

A  work  of  the  very  highest  importance — a  w#trk 
by  itself.— Loncfon  Med.  Gazette. 


SHARPEY  (WILLIAM),    M.  D.,    JONES   QUAIN,    M.  D.,  AND 
RICHARD  QUAIN,    F.  R.  S.,  &c. 

HUMAN  ANATOMY.     Revised,  with  Notes  and  Additions,  by  Joseph  Leidy, 

M.  D.     Complete  in  two  large  octavo  volumes,  of  about  thirteen  hundred  pages.    Beautifully 
illustrated  with  over  five  hundred  engravings  on  wood. 


It  is  indeed  a  work  calculated  to  make  an  era  in 
anatomical  study,  by  placing  before  the  student 
every  department  of  his  science,  with  a  view  to 
the  relative  importance  of  each  ;  and  so  skilfully 
have  the  different  parts  been  interwoven,  that  no 
one  who  makes  this  work  the  basis  of  his  studies, 
will  hereafter  have  any  excuse  for  neglecting  or 
undervaluing  any  important  particulars  connected 
with  the  structure  of  the  human  frame;  and 
whether  the  bias  of  his  mind  lead  him  in  a  more 
especial  manner  to  surgery,  physic,  or  physiology, 
he  will  find  here  a  work  at  once  so  comprehensive 
and  practical  as  to  defend  him  from  exclusiveness 
on  the  one  hand,  and  pedantry  on  the  other. — 
Monthly  Journal  and  Retrospect  of  the  Medical 
Sciences. 


We  have  no  hesitation  in  recommending  this  trea- 
tise on  anatomy  as  the  most  complete  on  that  sub- 
ject in  the  Engli.sh  language;  and  the  only  one, 
perhaps,  in  any  language,  which  brings  the  state 
of  knowledge  forward  to  the  most  recent  disco- 
veries.— The  Edinburgh  Med.  and  Surg.  Journal. 

Admirably  calculated  to  fulfil  the  object  for  vvhkh 
it  is  intended. — Provincial  Medical  Journal. 

The  most  complete  Treatise  on  Anatomy  in  the 
English  language. — Edinburgh  Medical  Journal. 

There  is  no  work  in  the  English  language  to  be 
preferred  to  Dr.  Quain's  Elements  of  Anatomy. — 
London  Journal  of  Medicine. 


SMITH  (HENRY    H.),  M.  D.,  AND   HORNER  (WILLIAM  E.),   M.  D. 

AN  ANATOMICAL  ATLAS,  illustrative  of  the  Structure  of  the  Human  Body. 
In  one  volume,  large  imperial  octavo,  with  about  six  hundred  and  fifty  beautiful  figures. 

late  the  student  upon  the  completion  of  this  Atlas, 
as  it  is  the  most  ccmvenient  work  of  the  kind  that 
has  yet  appeared  ;  and  we  must  add,  the  very  beau- 
tiful manner  in  which  it  is  "  got  up"  is  so  creditable 


These  figures  are  well  selected,  and  present  a 
complete  and  accurate  representation  of  that  won- 
derful fabric,  the  human  body.  The  plan  of  this 
Atlas,  which  renders  it  so  peculiarly  convenient 
for  the  student,  and  its  superb  artistical  execution, 
have  been  already  pointed  out.     We  must  congratu- 


to  the  country  as  to  be  flattering  to  our  national 
pride. — American  Medical  Journal. 


In 


SARGENT  (F.  W.),   M.  D. 
ON  BANDAaiNO  AND  OTHER  POINTS  OF  MINOR  SURGERY. 

one  handsome  royal  12mo.  volume  of  nearly  400  pages,  with  128  wood-cuts. 

The  very  best  manual  of  Minor  Surgery  we  have  l      We  have  carefully  examined  this  work,  and  find  it 
Been;an  American  volume,  with  nearly  four  hundred  [well  executed  and  admirably  adapted  to  the  use  of 

Besides  the  subjects  usually  embraced 


pages  of  good  practical  lessons,  illustrated  by  about 
one  hundred  and  thirty  wood-cuts.  In  these  days 
o(  ''  trial,"  when  a  doctor's  reputation  hangs  upon 
a  clove  hitch,  or  the  roll  of  a  bandage,  it  would  be 
well,  perhaps,  to  carry  such  a  volume  as  Mr.  Sar- 
gent's always  in  our  coat-pocket,  or,  at  all  events, 
to  listen  attentively  to  his  instructions  a$  home. — 
Buffalo  Med.  Journal. 


the  student. 

in  works  on  Minor  Surgery,  there  is  a  short  chapter 
on  bathing,  another  on  anajsthetic  agents,  and  an 
appendix  of  formulae.  The  author  has  given  an  ex- 
cellent work  on  this  subject,  and  his  publishers  have 
illustrated  and  printed  it  in  most  beautiful  style. — 
The  Charleston  Medical  Journal. 


STANLEY  (EDWARD). 
A  TREATISE  ON  DISEASES  OF  THE  BONES. 

extra  cloth,  286  pages. 


In  one  volume,  octavo, 


AND    SCIENTIFIC    PUBLICATIONS. 


27 


STILLE  (ALFRED),  M.  D. 
PRINCIPLES  OF  THERAPEUTICS.     In  one  handsome  volume.  ^Preparing.) 


SIMON  (JOHN),  F.  R.  S. 
GENERAL    PATHOLOGY,    as  conducive  to  the  Establishment  of  Rational 

Principles   for  the  Prevention  and  Cure  of  Disease.    A  Course  of  Lectures  delivered 
Thomas's  Hospital  during  the  summer  Session  of  1850.    In  one  neat  octavo  volume. 


at  St 


SMITH  (TYLER  W.),  M.  D., 

Lecturer  on  Obstetrics  in  the  Hunterian  School  of  Medicine. 

ON   PARTURITION,   AND   THE    PRINCIPLES    AND   PRACTICE   OP 

OBSTETKICS.    In  one  large  duodecimo  volume,  of  400  pages. 


SIBSON   (FRANCIS),    M.D., 

Physician  to  St.  Mary's  Hospital. 

MEDICAL  ANATOMY.  Illustrating  the  Form,  Structure,  and  Position  of  the 
Internal  Organs  in  Health  and  Disease.  In  large  imperial  quarto,  Vf\\h.  splendid  colored  plates. 
To  match  "Maclise's  Surgical  Anatomy."     {Preparing.) 


SOLLY  (SAMUEL),   F.  R.  S. 
THE    HUMAN    BRAIN;    its  Structure,  Physiology,  and  Diseases.     With  a 
Description  of  the  Typical  Forms  of  the  Brain  in  the  Animal  Kingdom.    From  the  Second  and 
much  enlarged  London  edition.    In  one  octavo  volume,  with  120  wood-cuts. 


SCHOEDLER  (FRIEDRICH),   PH.D., 

Professor  of  the  Natural  Sciences  at  Worms,  &c. 

THE   BOOK  OF  NATURE;   an  Elementary  Introduction  to  the  Sciences  of 

Physics,  Astronomy,  Chemistry,  Mineralogy,  Geology,  Botany,  Zoology,  and  Physiolog>\  First 
American  edition,  with  a  Glossary  and  other  Additions  and  Improvements;  from  the  second 
English  edition.  Translated  from  the  sixth  German  edition,  by  Henry  Medlock,  F.  C.  S.,  &c. 
In  one  thick  volume,  small  octavo,  of  about  seven  hundred  pages,  with  679  illustrations  on  wood. 
Suitable  for  the  higher  Schools  and  private  students.  {Now  Ready.) 
This  volume,  as  its  title  shows,  covers  nearly  all 
the  sciences,  and  embodies  a  vast  amount  of  informa- 
tion for  instruction.    No  other  work  that  we  have 


seen  presents  the  reader  with  so  wide  a  range  of  ele- 
mentary knowledge,  with  so  full  illustrations,  at  90 
cheap  a  rate. — Silliman-s  Journal^  Nov.  1853. 


TAYLOR  (ALFRED  S.),  M.  D.,  F.  R.  S., 

Lecturer  on  Medical  Jurisprudence  and  Chemistry  in  Guy's  Hospital. 

MEDICAL  JURISPRUDENCE.     Third  American,  from  the  fourth  and  improved 

English  Edition.    With  Notes  and  References  to  American  Decisions,  by  Edward  Hartshorne, 

M.  D.    In  one  large  octavo  volume,  of  about  seven  hundred  pages,     {Just  Issued.) 

We  know  of  no  work  on  Medical  Jurisprudence 
which  contains  in  the  same  space  anything  like  the 
same  amount  of  valuable  matter  .—JV.  Y.  Journal  of 
Medicine. 

The  American  editor  has  appended  several  im- 


portant facts,  the  whole  constituting  by  far  the  best, 
most  reliable,  and  interesting  treatise  on  Medical 
Jtrrisprudence,  and  one  that  we  cannot  too  strongly 
recommend  to  all  who  desire  to  become  acquainted 
with  the  true  and  correct  exposition  of  this  depart- 
ment of  medical  literature. — Northern  Lancet. 

No  work  upon  the  subject  can  be  put  into  the 
hands  of  students  either  of  law  or  medicine  which 
will  engage  them  more  closely  or  profitably ;  and 
none  could  be  offered  to  the  busy  practitioner  of 
either  calling,  for  the  purpose  of  casual  or  hasty 


reference,  that  would  be  more  likely  to  afford  the  aid 
desired.  We  tlierefore  recommend  it  as  the  best  and 
safest  manual  for  daily  use. — American  Journal  of 
Medical  Sciences. 


We  have  heretofore  had  reason  to  refer  to  it  in 
terms  of  commendation,  and  need  now  only  state 
that,  in  the  edition  before  us,  the  author  has  com- 
pletely revised  the  whole  work,  making  many  addi- 
tions and  alterations,  and  brought  it  fully  up  to  the 
present  state  of  knowledge.  The  task  of  the  Ameri- 
can editor  has  been  to  present  all  the  important 
facts  and  cases  that  have  recently  occurred  in  our 
own  country,  bearing  on  the  subjects  treated  of. 
No  better  work  can  be  placed  in  the  hands  of  the 
physician  or  jurist. — St.  Louis  Medical  and  Surgical 
Journal. 


BY   THE    SAME   AUTHOR. 

ON  POISONS,  IN  RELATION  TO   MEDICAL  JURISPRUDENCE   AND 

JVIEDICINE.    Edited,  with  Notes  and  Additions,  by  R.  E.  Griffith,  M.  D.    In  one  large  octavo 
volume,  of  688  pages. 

One  of  the  most  practical  and  trustworthy  works 

on   Poisons  in  our  language. — Western  Journal  of 

Medicine. 


The  most  elaborate  work  on  the  subject  that  our 
literature  possesses. — British  and  Foreign  Medico- 
Chirurgical  Review. 

It  contains  a  vast  body  of  facts,  which  embrace 
ail  that  is  important  in  toxicology,  all  that  is 
ttecessary  to  the  guidance  of  the  medical  jurist,  and 
all  that  can  be  desired  by  the  lawyer,  —  Medico- 
Chirurgical  Review. 


It  is,  so  far  as  our  knowledge  extends,  incompa- 
rably the  best  upon  the  subject;  in  the  highest  de- 
gree creditable  to  the  author,  entirely  trustworthy, 
and  indispensable  to  the  student  and  practitioner. — 
JV.  Y.  Annalist 


THOMSON  (A.  T.),  M.  D.,  F.  R.  S.,  &c. 
DOMESTIC  MANAGEMENT   OF   THE   SICK  ROOM,  necessary  in  aid  of 
Medical  Treatment  for  the  Cure  of  Diseases.    Edited  by  R,  E.  Griffith,  M.  D.    In  one  large 
royal  12mo.  volume,  with  wood-outs,  360  pages. 


(NMMil    i,U 


3$ 


B L AN C H A R D   &  LEA' S   Mfel) I C A L 


TOMES  (JOHN),    F.  R.  S. 
A  MANUAL  OF  DENTAL  PRACTICE.     Illustrated  by  numerous  engravings 

on  wood.    In  one  handsome  volume.     {Preparing.) 


TODD  (R.  B.),   M.  D.,  AND  BOWMAN  (WILLIAM),  F.  R.  S. 
PHYSIOLOaiCAL    ANATOMY  AND    PHYSIOLOaY  OF   MAN.     With 

numerous  handsome  wood-cuts.    Paris  I,  II,  and  III,  in  one  octavo  volume,  552  pages.     Part  IV 

will  complete  the  work. 

The  distinguishing  peculiarity  of  this  work  is,  that  the  authors  investigate  for  themselves  every 
fact  asserted ;  and  it  is  the  immense  labor  consequent  upon  the  vast  number  of  observations  re- 
quisite to  carry  out  this  plan,  which  has  so  long  delayed  the  appearance  of  its  completion.  Tlie 
first  portion  ot  Part  IV,  with  numerous  original  illustrations,  was  published  in  the  Medical  News 
and  Library  for  1853,  and  the  completion  will  be  issued  immediately  on  its  appearance  in  London. 
Those  who  have  subscribed  since  the  appearance  of  llie  preceding  portion  of  the  work  can  haw 
the  three  parts  by  mail,  on  remittance  of  $2  50  to  the  publishers. 

TRANSACTIONS  OF   THE   AMERICAN    MEDICAL  ASSOCIATION. 
VOLUME  VI,  for  1853,  large  8vo.,  of  870  pages,  with  numerous  colored  platea 

and  wood-cuts. 
Also  to  be  had,  a  few  sets  of  the  Transactions  from  1848  to  1853,  in  six  large  octavo  volumes, 
price  $25.     These  volumes  are  all  published  by  and  sold  on  account  of  the  Association. 

WATSON   (THOMAS),    M.D.,    &c. 
LECTURES    ON    THE   PHINCIPLES    AND    PRACTICE   OF   PHYSIC. 

Third  American,  from  the  last  London  edition.  Revised,  with  Additions,  by  D.  Francis  Condie, 
M.  D.,  author  of  a  "Treatise  on  the  Diseases  of  Children,"  &c.  In  one  octavo  volume,  of  nearly 
eleven  hundred  large  pages,  strongly  bound  with  raised  bands. 


To  say  that  it  is  the  very  best  work  on  the  sub- 
ject now  extant,  is  but  to  echo  the  sentiment  of  the 
medical  press  throughout  the  country.  —  N.  O. 
Medical  Journal, 

Of  the  text-books  recently  republished  Watson  is 
very  justly  the  principal  favorite. — Holmes's  Rep. 
to  Nat.  Med.  Assoc, 

By  universal  consent  the  work  ranks  among  the 
vxjry  best  text-books  in  our  language. — Illinois  and 
Indiana  Med.  Journal. 

Regarded  on  all  hands  as  one  of  the  very  best,  if 
not  the  very  best,  systematic  treatise  on  practical 
medicine  extant. — St.  Lxmis  Med.  Journal. 


Confessedly  one  of  the  very  best  works  on  tb« 
principles  and  practice  of  physic  in  the  English  or 
any  other  language. — Med.  Examiner. 

Asa  text-book  it  has  no  equal ;  as  a  compendium 
of  pathology  and  practice  no  superior.— iVet^"  York 
Annalist. 

We  know  of  no  work  better  calculated  for  being 
placed  in  the  hands  of  the  student,  and  for  a  text- 
book; on  every  important  point  the  author  seems 
to  have  posted  up  his  knowledge  to  the  day. — 
Amer.  Med.  Journal. 

One  of  the  most  practically  useful  books  that 
ever  was  presented  to  the  student.  —  N.  Y.  Med. 
Journal, 


WALSHE  (W.    H.),    M.  D., 

Professor  of  the  Principles  and  Practice  of  Medicine  in  University  College,  London. 

DISEASES    OF    THE    HEART,    LUNGS,    AND    APPENDAGES;    their 

Symptoms  and  Treatment.    In  one  handsome  volume,  large  royal  12mo.,  512  pages. 
We  consider  this  as  the  ablest  work  in  the  En-  1  the  author  being  the  first  stethoscopist  of  the  day.— 
gfieh  language,  on  the  subject  of  which  it  treats;  |  Charleston  Medical  Journal. 

WHAT   TO   OBSERVE 
AT    THE    BEDSIDE    AND    AFTER   DEATH,    IN    MEDICAL    CASE,S. 


published  under  the  authority  of  the  London  Society  for  Medical  Observation, 
handsome  volume,  royal  12mo  ,  extra  cloth.     {Just  Issued.) 


In  one  very 


We  hail  the  appearance  of  this  book  as  the  grand 
desideratum. — Charleston  Medical  Journal. 

This  is  truly  a  very  capital  book.  The  whole 
medical  world  will  reap  advantages  from  its  publi- 
cation. The  medical  journals  will  soon  show  its 
influence  on  the  character  of  the  "  Reports  of  Cases" 
which  they  publish.    Drs.  Ballard  and  Walshe  have 


given  to  the  world,  through  a  small  but  useful 
medical  organization,  a  cheap  but  invaluable  book. 
We  do  advise  every  reader  of  this  notice  to  buy  it 
and  use  it.  Unless  he  is  so  vain  as  to  imagine  him- 
self superior  to  the  ordinary  human  capacity,  he  wiW 
in  six  months  tee  its  inestimable  advantages.— 
Stethoscope. 


WILDE   (W.    R.),  'OPTm     • 

Surg-eon  to  St.  Mark's  Ophthalmic  and  Aural  Hospital,  Dublin. 

AURAL  SURGERY,  AND  THE  NATURE  AND  TREATMENT  OF  DIS- 

EASES  OF  THE  EAR.  In  one  handsome  octavo  volume,  with  illustrations.  {Now  Ready.) 
So  little  is  generally  known  in  this  country  concerning  the  causes,  symptoms,  and  treatment  of 
aural  affections,  that  a  practical  and  scientific  work  on  that  subject,  from  a  practitioner  of  Mr. 
Wilde's  great  experience,  cannot  fail  to  be  productive  of  much  benefit,  by  attracting  attention 
lo  this  obscure  class  of  diseases,  which  too  frequently  escape  attention  until  past  relief  The  im- 
mense number  of  cases  which  have  come  under  Mr.  Wilde's  observation  for  many  years,  have 
afforded  him  opportunities  rarely  enjoyed  for  investigating  this  branch  of  medical  science,  and  hia 
work  may  therefore  be  regarded  as  of  the  highest  authority. 

This  work  certainly  contains  more  information  on 
the  subject  to  which  it  is  devoted  than  any  other 
with  which  we  are  acquainted.  We  feel  grateful  to 
the  author  for  his  manful  effort  to  rescue  this  depart- 


ment of  surgery  from  the  hands  of  the  empirics  who 
nearly  monopolize  it.  We  think  he  has  successfully 
shown  that  aural  diseases  are  not  beyond  the  re- 
sources of  art;  that  they  are  governed  by  the  same 


laws,  and  amenable  to  the  same  general  methods  of 
treatment  as  other  morbid  processes.  The  work  \% , 
not  written  to  supply  the  cravings  of  popular  patro- 
nage, but  it  is  wholly  addressed  to  tlie  profession, 
and  bears  on  every  page  the  impress  of  the  reflections 
of  a  sagacious  and  practical  surgeon.—  Va.  Surg,  and 
Med.  Journal. 


AND   SCIENTIFIC    PUBLICATIONS. 


f9 


WILSON    (ERASMUS),  M.D.,    F.  R.  S., 

Lecturer  on  Anatomy,  London. 

A  SYSTEM  OF  HUMAN  ANATOMY,  General  and  Special.     Fourth  Ameri- 

can,  from  the  last  English  edition.  Edited  by  Paul  B.  Goddard,  A.  iM.,  M.  D.  With  two  hun- 
dred and  fifty  illustrations.  Beautifully  printed,  in  one  large  octavo  volume,  of  nearly  six  hun- 
dred pages. 

In  many,  if  not  all  the  Colleges  of  the  Union,  it 
has  become  a  standard  text-book.     This,  of  itself, 


is  sufficiently  expressive  of  its  value.  A  work  very 
desirable  to  the  student;  one,  the  possession  of 
which  will  greatly  facilitate  his  progress  in  the 
study  of  Practical  Anatomy. — New  York  Journal  of 
Medicine. 

Its  author  ranks  with  the  highest  on  Anatomy. — 
Southern  Medical  and  Surgical  Journal. 


It  offers  to  the  student  all  the  assistance  that  can 
be  expected  from  such  a  work. — Medical  Examiner. 

The  most  complete  and  convenient  manual  for  the 
student  we  possess. — American  Journal  of  Medittd 

Science. 

In  every  respect,  this  work  as  an  anatomical 
guide  for  the  student  and  practitioner,  merits  our 
warmest  and  most  decided  praise. — London  Medical 
Gazette. 


BY  THE  SAME  AUTHOR. 

THE  DISSECTOR;  or,  Practical  and  Surgical  Anatomy.  Modified  and  Re- 
arranged, by  Paul  Beck  Goddard,  M.  U.  A  new  edition,  with  Revisions  and  Additions.  In 
one  large  and  handsome  volume,  royal  12mo.,  with  one  hundred  and  fifteen  illustrations. 

In  passing  this  work  again  through  the  press,  the  editor  has  made  such  additions  and  improve- 
ments as  the  adv^ance  of  anatomical  knowledge  has  rendered  necessary  to  maintain  the  work  in  the 
high  reputation  which  it  has  acquired  in  the  schools  of  the  United  States,  as  a  complete  and  faithftil 
guide  to  the  student  of  practical  anatomy.  A  number  of  new  illustrations  have  been  added,  espe- 
cially in  the  portion  relating  to  the  complicated  anatomy  of  Hernia.  In  mechanical  execution  tb« 
work  will  be  found  superior  to  former  editions. 


ON   DISEASES    OF  THE 


BY    THE   SAME   AUTHOR. 

SKIN.  Third  American,  from  the  third  London 
edition.  In  one  neat  octavo  volume,  of  about  five  hundred  pages,  extra  cloth.  (J  its  t  Is  sited.) 
Also,  to  be  had  done  up  with  fifteen  beautiful  steel  plates,  of  which  eight  are  exquisitely  colored  ; 
representing  the  Normal  and  Pathological  Anatomy  of  the  Skin,  together  with  accurately  colored 
delineations  of  more  than  sixty  varieties  of  disease,  most  of  them  the  size  of  nature.  The  PlatefS 
are  also  for  sale  separate,  done  up  in  boards. 

The  increased  size  of  this  edition  is  sufficient  evidence  that  the  author  has  not  been  content 
with  a  mere  republication,  but  has  endeavored  to  maintain  the  high  character  of  his  work  as  the 
standard  text-book  on  this  interesting  and  difficult  class  of  diseases.  He  has  thus  introduced  such 
new  matter  as  the  experience  of  the  last  three  or  four  years  has  suggested,  and  has  made  such 
alterations  as  the  progress  of  scientific  investigation  has  rendered  expedient.  The  illustrations  have 
also  been  materially  augmented,  the  number  of  plates  being  increased  from  eight  to  sixteen. 

The  "Diseases  of  the  Skin,"  by  Mr.  Erasmus 


Of  these  plates  it  is  impossible  to  speak  too  highly. 
The  representations  of  the  various  forms  of  cuta- 
neous disease  are  singularly  accurate,  and  the  color- 
ing exceeds  almost  anything  we  have  met  with  in 
ptnnt  of  delicacy  and  finish. — British  and  Foreign 
Medical  Review. 


by  Mr. 
Wilson,  may  now  be  regarded  as  the  standard  work 
in  that  department  of  medical  literature.  The 
plates  by  wliich  this  edition  is  accompanied  leave 
nothing  to  be  desired,  so  far  as  excellence  of  delinea- 
tion and  perfect  accuracy  of  illustration  are  con- 
eorned. — Medico-Chirurgical  Review. 

BY  THE  SAME   AUTHOR. 

ON    CONSTITUTIONAL    AND    HEREDITARY    SYPHILIS,   AND    ON 

SYPHILITIC  ERUPTIONS.    In  one  small  octavo  volume,  beautifully  printed,  with  four  exqui- 
site colored  plates,  presenting  more  than  thirty  variettes  of  syphilitic  eruptions. 

Dr.  Wilson's  views  on  the  general   subject  of  connection  with  its  transmissibility,  pathology  and 

Syphilis  appear  to  us  in  the  main  sound  and  judi-  sequelae.  His  facts  and  references  will,  we  are  satis- 

cious,  and  we  commend  the  book  as  an  excellent  fied,  be  received  as  decisive,   in  regard  to  many 

monograph  on  the   subject.    Dr.  Wilson   has  pr^-  questiones  vexata;.     They  appear  to  us  entitled  to 

sented   us  a  very  faithful   and  lucid  description  of  notice  at  some  length. — Medical  Examiner. 
Syphilis  and  has  cleared  up  many  obscure  points  in 

BY   THE   SAME   AUTHOR.      (NoW  Read?/.) 

HEALTHY  SKIN;  A  Popular  Treatise  on  the  Skin  and  Hair,  their  Preserva- 
tion and  Management.  Second  American,  from  the  fourth  London  edition.  One  neat  voluro«, 
royal  12mo.,  with  numerous  illustrations. 

Copies  can  be  had  done  up  in  paper  covers  for  mailing,  price  75  cents. 


WHITEHEAD  (JAMES),    F.  R.  C.  S 
THE  CAUSES  AND  TREATMENT 

being  the  Result  of  an  Extended  Practical  Inq 
Second  American  Edition.    In 


&-C, 


of  the  Uterus. 

The  simple  title  of  this  work  gives  a  very  imper- 
fect idea  of  its  contents.  The  subject  of  sterility 
occupies  a  mere  fraction  of  space,  and  upwards  of 
one-half  of  the  whole  volume  is  taken  up  with  an 
elaborate  account  of  menstruation  as  a  physiological 
process,  and  of  the  disorders  which  its  deviations 
from  health  are  apt  to  produce. — Medical  Chirurg. 
Review . 

Such  are  the  adyances  made  from  year  to  year  in 


OF  ABORTION  AND   STERILITY; 

uiry  into  the  Physiological  and  Morbid  Conditions 
one  volume,  octavo,  368  pages.  {Now  Ready.) 
this  department  of  our  profession,  thnt  the  practi- 
tioner who  does  not  consult  the  recent  works  on  the 
complaints  of  females,  will  soon  find  himself  in  tb« 
rear  of  his  more  studious  bretiiren.  This  is  one  of 
the  works  which  must  be  studied  by  those  who 
would  know  what  the  present  state  of  our  kmnvledg« 
is  respecting  the  causes  and  treatment  of  abortion 
and  sterility. — The  Western  Journal  of  Medicin4  cmd 
Surgery. 


30 


BLANCHARD   &   LEA'S   MEDICAL 


WEST   (CHARLES),    M.  D., 

Physician  to  the  Hospital  for  Sick  Children,  &c. 

LECTURES    ON   THE    DISEASES    OF  INFANCY  AND   CHILDHOOD. 

Second  American,  from  the  Second  and  Enlarged  London  edition.     In  one  volume,  octavo,  of 
nearly  five  hundred  pages.    {Now  Ready.) 

From  the  Preface  to  the  Second  Edition. 
In  the  preparation  of  the  second  edition  of  these  Lectures,  the  whole  work  has  been  carefully 
revised.  A  few  formulae  have  been  introduced  and  a  minute  alphabetical  index  has  been  appended 
while  additions  amounting  altogether  to  fifty  pages,  have  been  made,  wherever  I  felt  that  more 
extended  observation,  or  more  careful  reflection  had  enabled  me  to  supply  some  of  those  deficiencies 
which  I  am  well  aware,  are  still  far  too  numerous.  The  work  now  contains  the  result  of  640 
observations,  and  199  post-mortem  examinations,  chiefly  made  among  16,276  children  who  came 
under  my  notice  during  the  ten  years  of  my  connection  with  the  Children's  Infirmary  in  Lambeth. 

We  take  leave  of  Dr.  West  with  great  respect  for 
his  attainments,  a  due  appreciation  of  his  acute 
powers  of  observation,  and  a  deep  sense  of  obliga- 
tion for  this  valuable  contribution  to  our  profes- 
sional literature.  His  book  is  undoubtedly  in  manj' 
respects  the  best  we  possess  on  diseases  of  children. 
The  extracts  we  have  given  will,  we  hope,  satisfy 
our  readers  of  its  value ;  and  yet  in  all  candor  \ve 
must  say  that  they  are  even  inferior  to  some  other 
parts,  the  length  of  which  prohibited  our  entering 
upon  them.  That  the  book  will  shortly  be  in  the 
hands  of  most  of  our  readers  we  do  not  doubt,  and  it 
will  give  us  much  pleasure  if  our  strong  recommend- 
ation of  it  may  contribute  towards  the  result.— TAe 
Dtiblin  Quarterly  Journal  of  Medical  Science. 


Dr.  West  has  placed  the  profession  under  deep  ob- 
ligation by  this  able,  thorough,  and  finished  work 


upon  a  subject  which  almost  daily  taxes  to  the  ut- 
most the  skill  of  the  general  practitioner.  He  has 
with  singular  felicity  threaded  his  way  through  all 
the  tortuous  labyrinths  of  the  difficult  subject  he  has 
undertaken  to  elucidate,  and  has  in  many  of  the 
darkest  corners  left  a  light,  for  the  benefit  of  suc- 
ceeding travellers,  which  will  never  be  extinguished. 
Not  the  least  captivating  feature  in  this  admirable 
performance  is  its  easy,  conversational  style,  w^hich 
acquires  force  from  its  very  simplicity,  and  leaves 
an  impression  upon  the  memory,  of  the  truths  it 
conveys,  as  clear  and  refreshing  as  its  own  purity. 
The  author's  position  secured  him  extraordinary  fa- 
cilities for  the  investigation  of  children's  diseases, 
and  his  powers  of  observation  and  discrimination 
have  enabled  him  to  make  the  most  of  these  great 
advantages. — Nashville  Medical  Journal. 


BY  THE  SAME  AUTHOR.      [NoiV  Ready.) 

AN  ENQUIRY  INTO  THE  PATHOLOaiCAL  IMPORTANCE  OF  ULCER- 
ATION OF  THE  OS  UTERI.  Being  the  Croonian  Lectures  for  the  year  1854.  In  one  neat 
octavo  volume,  extra  cloth. 

This  work  will  appear  in  the  "  Medical  News  and  Library"  during  the  latter  portion  of  1854,  and 
will  be  published  in  a  separate  form  about  December. 


WILLIAMS  (C.  J.   B.),    M.  D.,    F.  R.  S., 

Professor  of  Clinical  Medicine  in  University  College,  London,  &o. 

PRINCIPLES  OF  MEDICINE;  comprising  General  Pathology  and  Therapeu- 
tics, and  a  brief  general  view  of  Etiology,  Nosology,  Semeiology,  Diagnosis,  Prognosis,  and 
Hygienics.  Edited,  with  Additions,  by  Meredith  Clymer,  M.  D.  Fourth  American,  from  the 
last  and  enlarged  London  edition.     In  one  octavo  volume,  of  476  pages.     {Now  Ready.) 

This  new  edition  has  been  materially  enlarged  and  brought  up  by  the  editor. 

It  possesses  the  strongest  claims  to  the  attention  of  the  medical  student  and  practitioner,  from 
the  admirable  manner  in  which  the  various  inquiries  in  the  diflerent  branches  of  pathology  are 
investigated,  combined,  and  generalized  by  an  experienced  practical  physician,  and  directly  applied 
to  the  investigation  and  treatment  of  disease. — Editor's  Preface. 


The  best  exposition  in  our  language,  or,  we  be- 
lieve, in  any  language,  of  rational  medicine,  in  its 
present  improved  and  rapidly  improving  state. — 
British  and  Foreign  Medico-Chirurg.  Review. 


Few  books  have  proved  more  useful,  or  met  with 
a  more  ready  sale  than  this,  and  no  practitioner 
should  regard  his  library  as  complete  without  it. 
— Ohio  Med.  and  Surg.  Journal. 


BY   THE   SAME   AUTHOR. 


A  PRACTICAL  TREATISE   ON   DISEASES   OF  THE   RESPIRATORY 

ORGANS;  including  Diseases  of  the  Larynx,  Trachea,  Lungs,  and^Pleurse.     With  numerous 
Additions  and  Notes,  by  M.  Clymer,  M.  D.    With  wood-cuts.    In  one  octavo  volume,  pp.  508. 


YOUATT   (WILLIAM),  V.  S. 

THE  HORSE.  A  new  edition,  with  numerous  illustrations;  together  with  a 
general  history  of  the  Horse;  a  Dissertation  on  the  American  Trotting  Horse;  how  Trained  and 
Jockeyed ;  an  Account  of  his  Remarkable  Performances ;  and  an  Essay  on  the  Ass  and  the  Mule. 
By  J.  S.  Skinner,  formerly  Assistant  Postmaster-General,  and  Editor  of  the  Turf  Register. 
One  large  octavo  volume. 


BY    THE   SAME   AUTHOR. 


THE   DOa. 

illustrations. 


Edited  by  E.  J.  Lewis,   M.  D. 

In  one  very  handsome  volume,  crown  8vo. 


With   numerous 
crimson  cloth,  gilt. 


and  beautiful 


AND   SCIENTIFIC    PUBLICATIONS. 


hdn 


31 


B.  &  L.  subjoin  a  condensed  list  of  their  publications  in  general  and  educational 
literature,  of  which  more  detailed  catalogues  will  be  furnished  on  application. 
HISTORY  AND  BIOGRAPHY. 


BROWNING'S  HISTORY  OF  THE  HUGUE 
NOTS,  1  vol.  8vo. 

CAMPBELL'S  (LORD)  LIVES  OF  THE  LORD 
CHANCELLORS  OF  ENGLAND,  from  the  earl- 
iest I'imes  to  the  Reign  of  George  IV.  In  seven 
handsome  crown  octavo  volumes,  extra  cloth  or 
half  morocco. 

GAVIPBELL  S  (LORD)  LIVES  OF  THE  CHIEF 
JUSTICES  OF  ENGLAND,  from  the  Norman 
Conquest.  In  two  hand.some  crown  octavo  vols., 
to  match  the  "  Chancellors." 

DiXON'S  LIFE  OF  WILLIAM  PENN.  A  new 
work.    1  vol.  royal  liimo.,  extra  cloth. 

GRAHAME'S  COLONIAL  HISTORY  OF  THE 
TTNITED  STATES.    2  vols.  8vo.    A  new  edition. 

GUIZOT'S  LIFE  OF  CROMWELL.  Two  large 
vols.,  royal  12mo.    (Now  readv.) 

HERVEY'S  MEMOIRS  OF  GEORGE  II.  2  vols, 
royal  12mo.,  extra  cloth. 

HUGIIESS  OUTLINES  OF  SCRIPTURE  GEO- 
GRAPHY AND  HISTORY,  I  vol.,  royal  12mo., 
with  colored  maps.     (Just  issued.) 

IIVGERSOLL'S  HISTORY  OF  THE  LATE  WAR. 
2  vols  8vo. 

KENNEDY'S  LIFE  OF  WILLIAM  WIRT.  2d 
edition,  2  vols,  royal  l2mo.,  extra  cloth,  with  Por- 
trait. 

Same  work,  library  edition,  2  vols.  8vo. 

KAVANAGHS  WOMAN  IN  FRANCE  IN  THE 
EIGHTEENTH  CENTURY.  1  vol.  royal  12mo., 
extra  cloth. 

LOUIS  BLANC'S  FRANCE  UNDER  LOUIS  PHI- 
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LOUIS  BLANC'S  FRENCH  REVOLUTION.  1  V9l. 

crown  8vo  ,  extra  cloth. 
MARSH  (MRS.)  ROMANTIC  HISTORY  OF  THE 
HUGUENOTS.    2  vols,  royal  12mo.,  extra  cloth. 
NIEBUHRS  ANCIENT  HISTORY.  By  Leonhard 

ScHMiTz.    It)  three  handsome  crown  octavo  vols., 

(Lately  Issued.) 
PARDOE'S  FRANCIS  THE  FIRST.    2  vols,  royal 

12mo..  extra  cloth. 
PALGRAVE'S   NORMANDY  AND    ENGLAND. 

In  three  vols,  crown  8vo.,  (Preparing.) 
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RANKE'S  HISrORY  OF    IHE   REFORMATION 

IN  GERMANY.    To  be  complete  in  1  vol.  8vo. 
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SPANISH  EMPIRES.    8vo.    Price  50  cents. 
RUSSEL'S   LIFE  OF   CHARLES    JAMES  POX. 

2  vols.,  handsome  royal  12mo.    (Now  ready.) 
Same  Work,  Second  Series.    (Preparing  ) 
STRICKLAND'S    LIVES  OF  THE  QUEENS  OF 

ENGLAND,  from  the   Norman   Conquest.    Conr>- 

plete  in  6  handsome  crown  8vo.  volumes,  various 

styles  of  binding. 
STRICKLAND'S   LIVES  OF  THE  QUEENS  OF 

HENRY  VIII.    Ill  one  handsome  crown  8vo.  vol., 

extra  cloth,  various  styles. 
STRICKLAND'S  LIFE  OF  QUEEN  ELIZABETH. 

In  one  handsome  crown  8vo.  volume,  extra  cloth, 

various  styles. 
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2  vols,  crown  8vo.,  extra  cloth. 


MISCELLANEOUS. 


ACTON  (MRS.)  MODERN  COOKERY.    Edited  by 

Mrs.  S  J.  Hale.    1  handsome  volume,  royal  12mo., 

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